Provider Demographics
NPI:1750497913
Name:LISA M GIANNONE ET AL PTR
Entity Type:Organization
Organization Name:LISA M GIANNONE ET AL PTR
Other - Org Name:ACTIVE CARE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIANNONE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:415-387-6564
Mailing Address - Street 1:3019 GEARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3314
Mailing Address - Country:US
Mailing Address - Phone:415-387-6564
Mailing Address - Fax:415-387-2013
Practice Address - Street 1:3019 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118
Practice Address - Country:US
Practice Address - Phone:415-387-6564
Practice Address - Fax:415-387-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25853ZOtherMEDICARE
ZZZ25853ZMedicare ID - Type Unspecified