Provider Demographics
NPI:1013256361
Name:MILL VALLEY PHYSICAL THERAPY PARTNERSHIP
Entity Type:Organization
Organization Name:MILL VALLEY PHYSICAL THERAPY PARTNERSHIP
Other - Org Name:MILL VALLEY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HESCHONG
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:415-388-5223
Mailing Address - Street 1:619 E BLITHEDALE AVE
Mailing Address - Street 2:BLDG. B
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1482
Mailing Address - Country:US
Mailing Address - Phone:415-388-5223
Mailing Address - Fax:415-388-5270
Practice Address - Street 1:619 E BLITHEDALE AVE
Practice Address - Street 2:BLDG. B
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1482
Practice Address - Country:US
Practice Address - Phone:415-388-5223
Practice Address - Fax:415-388-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty