Provider Demographics
NPI:1861483117
Name:STUART HARRIS BAY AREA PHYSICAL THERAPY
Entity Type:Organization
Organization Name:STUART HARRIS BAY AREA PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-570-0510
Mailing Address - Street 1:911 MORAGA RD
Mailing Address - Street 2:#103
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4579
Mailing Address - Country:US
Mailing Address - Phone:925-284-3840
Mailing Address - Fax:925-284-3873
Practice Address - Street 1:911 MORAGA RD
Practice Address - Street 2:#103
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4579
Practice Address - Country:US
Practice Address - Phone:925-284-3840
Practice Address - Fax:925-284-3873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2008-06-26
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
CA1047914OtherCIGNA
CAZZZ45863ZOtherBLUESHIELD
CA171468600OtherDOL
CA8157055OtherAETNA
CA8157055OtherAETNA