Provider Demographics
NPI:1205383213
Name:LANDS END PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:LANDS END PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CERRA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:415-524-7390
Mailing Address - Street 1:44 GOUGH ST STE 308
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-5424
Mailing Address - Country:US
Mailing Address - Phone:415-524-7390
Mailing Address - Fax:
Practice Address - Street 1:44 GOUGH ST
Practice Address - Street 2:SUITE 308
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-5422
Practice Address - Country:US
Practice Address - Phone:917-703-3343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty