Provider Demographics
NPI:1639754245
Name:NETIC PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:NETIC PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:NOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:415-205-0781
Mailing Address - Street 1:2208 DWIGHT WAY APT 5
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2143
Mailing Address - Country:US
Mailing Address - Phone:510-761-9354
Mailing Address - Fax:
Practice Address - Street 1:1390 MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-5404
Practice Address - Country:US
Practice Address - Phone:510-761-9354
Practice Address - Fax:949-276-3039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy