Provider Demographics
NPI:1508105388
Name:BLUEJACKET WELLNESS, INC.
Entity Type:Organization
Organization Name:BLUEJACKET WELLNESS, INC.
Other - Org Name:THERAPYDIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:415-235-3834
Mailing Address - Street 1:47 MAIDEN LN
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-5401
Mailing Address - Country:US
Mailing Address - Phone:415-235-3834
Mailing Address - Fax:
Practice Address - Street 1:47 MAIDEN LN
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-5401
Practice Address - Country:US
Practice Address - Phone:415-235-3834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28859261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy