Provider Demographics
| NPI: | 1124103197 |
|---|---|
| Name: | THERAPISTA, INC. |
| Entity type: | Organization |
| Organization Name: | THERAPISTA, INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | ANGELA |
| Authorized Official - Middle Name: | DAWN |
| Authorized Official - Last Name: | ISAAC |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PT |
| Authorized Official - Phone: | 415-648-0196 |
| Mailing Address - Street 1: | 630 MOULTRIE ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SAN FRANCISCO |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 94110-6034 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 415-648-0196 |
| Mailing Address - Fax: | 415-374-7058 |
| Practice Address - Street 1: | 630 MOULTRIE ST |
| Practice Address - Street 2: | |
| Practice Address - City: | SAN FRANCISCO |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 94110-6034 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 415-648-0196 |
| Practice Address - Fax: | 415-374-7058 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-10-26 |
| Last Update Date: | 2009-11-24 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 252Y00000X | Agencies | Early Intervention Provider Agency | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing | Group - Multi-Specialty |
| No | 225XL0004X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Low Vision | Group - Multi-Specialty |
| No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
| No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
