Provider Demographics
NPI:1760497119
Name:MARAT DINER
Entity Type:Organization
Organization Name:MARAT DINER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARAT
Authorized Official - Middle Name:
Authorized Official - Last Name:DINER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:415-929-7677
Mailing Address - Street 1:2299 POST ST
Mailing Address - Street 2:SUITE LL-8
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3443
Mailing Address - Country:US
Mailing Address - Phone:415-929-7677
Mailing Address - Fax:415-929-7877
Practice Address - Street 1:2299 POST ST
Practice Address - Street 2:SUITE LL-8
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3443
Practice Address - Country:US
Practice Address - Phone:415-929-7677
Practice Address - Fax:415-929-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGPT001061Medicaid
CAGPT001060Medicaid
CAGPT001061Medicaid