Provider Demographics
NPI:1790979151
Name:EZ REHAB PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:EZ REHAB PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EWA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZABOROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:415-381-9030
Mailing Address - Street 1:PO BOX 10755
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94912-0755
Mailing Address - Country:US
Mailing Address - Phone:415-381-9030
Mailing Address - Fax:415-381-9040
Practice Address - Street 1:591 REDWOOD HWY STE 5210
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3017
Practice Address - Country:US
Practice Address - Phone:415-381-9030
Practice Address - Fax:415-381-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19645225100000X, 2251S0007X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPT196450Medicare PIN