Provider Demographics
NPI:1184852766
Name:ACTIVE MARIN PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:ACTIVE MARIN PHYSICAL THERAPY INC
Other - Org Name:CYNTHIA LEWTON DEHAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LEWTON
Authorized Official - Last Name:DEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:415-225-2923
Mailing Address - Street 1:5 BON AIR RD # C116
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1143
Mailing Address - Country:US
Mailing Address - Phone:415-225-2923
Mailing Address - Fax:415-924-1770
Practice Address - Street 1:5 BON AIR RD #C116
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1143
Practice Address - Country:US
Practice Address - Phone:415-225-2923
Practice Address - Fax:415-924-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24013261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy