Provider Demographics
NPI:1205221256
Name:BEACON PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:BEACON PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, FFMT, FAAOMPT
Authorized Official - Phone:415-772-0997
Mailing Address - Street 1:22 BATTERY ST
Mailing Address - Street 2:SUITE 802
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-5505
Mailing Address - Country:US
Mailing Address - Phone:415-772-0997
Mailing Address - Fax:415-772-0997
Practice Address - Street 1:22 BATTERY ST
Practice Address - Street 2:SUITE 802
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-5505
Practice Address - Country:US
Practice Address - Phone:415-772-0997
Practice Address - Fax:415-772-0997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41675261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy