Provider Demographics
NPI:1174662803
Name:ACE PHYSICAL THERAPY & SPORTS MEDICINE
Entity Type:Organization
Organization Name:ACE PHYSICAL THERAPY & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:AZCARATE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, AT, C
Authorized Official - Phone:415-777-5009
Mailing Address - Street 1:645 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1516
Mailing Address - Country:US
Mailing Address - Phone:415-777-5009
Mailing Address - Fax:415-777-5882
Practice Address - Street 1:645 5TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1516
Practice Address - Country:US
Practice Address - Phone:415-777-5009
Practice Address - Fax:415-777-5882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT2203002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ27837ZMedicare ID - Type Unspecified
CAS71814Medicare UPIN