Provider Demographics
NPI:1285858282
Name:MISSION DISTRICT PHYSICAL THERAPY & REHABILITATION INC
Entity Type:Organization
Organization Name:MISSION DISTRICT PHYSICAL THERAPY & REHABILITATION INC
Other - Org Name:MISSION PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-824-4228
Mailing Address - Street 1:1800 SULLIVAN AVE
Mailing Address - Street 2:RM 308
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2228
Mailing Address - Country:US
Mailing Address - Phone:415-824-4137
Mailing Address - Fax:415-824-4678
Practice Address - Street 1:1800 SULLIVAN AVE
Practice Address - Street 2:RM 308
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2228
Practice Address - Country:US
Practice Address - Phone:415-824-4137
Practice Address - Fax:415-824-4678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty