Provider Demographics
NPI:1558435727
Name:ULTRAHEALTH INC
Entity Type:Organization
Organization Name:ULTRAHEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:MINJARES
Authorized Official - Last Name:MATTOX
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:415-986-4979
Mailing Address - Street 1:220 MONTGOMERY ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-3402
Mailing Address - Country:US
Mailing Address - Phone:415-986-4979
Mailing Address - Fax:415-986-6951
Practice Address - Street 1:220 MONTGOMERY ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3402
Practice Address - Country:US
Practice Address - Phone:415-986-4979
Practice Address - Fax:415-986-6951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT82842081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT82840Medicare ID - Type Unspecified