Provider Demographics
NPI:1740210715
Name:WEST MARIN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:WEST MARIN PHYSICAL THERAPY
Other - Org Name:WEST MARIN PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDA
Authorized Official - Middle Name:DOROTHY
Authorized Official - Last Name:WEITZER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:415-663-9216
Mailing Address - Street 1:PO BOX 1264
Mailing Address - Street 2:
Mailing Address - City:POINT REYES STATION
Mailing Address - State:CA
Mailing Address - Zip Code:94956-1264
Mailing Address - Country:US
Mailing Address - Phone:415-663-9216
Mailing Address - Fax:
Practice Address - Street 1:11431 STATE ROUTE ONE
Practice Address - Street 2:SUITE 9
Practice Address - City:POINT REYES STATION
Practice Address - State:CA
Practice Address - Zip Code:94956
Practice Address - Country:US
Practice Address - Phone:415-663-9216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13083225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ02294ZMedicare ID - Type Unspecified
CAY53980Medicare UPIN