Provider Demographics
NPI:1508947474
Name:EMBARCADERO PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:EMBARCADERO PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:GO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:415-362-2442
Mailing Address - Street 1:88 JACKSON STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111
Mailing Address - Country:US
Mailing Address - Phone:415-362-2442
Mailing Address - Fax:415-362-2790
Practice Address - Street 1:88 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111
Practice Address - Country:US
Practice Address - Phone:415-362-2442
Practice Address - Fax:415-362-2790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ23986ZMedicare ID - Type Unspecified