Provider Demographics
NPI:1528223013
Name:MARINA PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:MARINA PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:MANCHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:831-883-8542
Mailing Address - Street 1:292 RESERVATION RD
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-3110
Mailing Address - Country:US
Mailing Address - Phone:831-883-8542
Mailing Address - Fax:831-883-8526
Practice Address - Street 1:292 RESERVATION RD
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-3110
Practice Address - Country:US
Practice Address - Phone:831-883-8542
Practice Address - Fax:831-883-8526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT281510261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACT610AMedicare PIN