Provider Demographics
NPI:1700816691
Name:GOLDEN GATE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:GOLDEN GATE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-776-1646
Mailing Address - Street 1:1801 BUSH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5296
Mailing Address - Country:US
Mailing Address - Phone:415-776-1646
Mailing Address - Fax:415-776-1964
Practice Address - Street 1:1801 BUSH ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109
Practice Address - Country:US
Practice Address - Phone:415-776-1646
Practice Address - Fax:415-776-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9854261QP2000X
CAPT 25031261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA196923400OtherACS
CAZZZ21382ZMedicare ID - Type Unspecified