Provider Demographics
NPI:1467465286
Name:NOE VALLEY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:NOE VALLEY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAUFMAN-NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:415-821-4148
Mailing Address - Street 1:1579 SANCHEZ ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-2329
Mailing Address - Country:US
Mailing Address - Phone:415-821-4148
Mailing Address - Fax:415-821-4004
Practice Address - Street 1:1579 SANCHEZ ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-2329
Practice Address - Country:US
Practice Address - Phone:415-821-4148
Practice Address - Fax:415-821-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29556ZOtherBLUE SHIELD
CAZZZ17858ZMedicare PIN