Provider Demographics
NPI:1245350651
Name:QUACH, JANE (PT)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:QUACH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 BUSH ST 100
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3121
Mailing Address - Country:US
Mailing Address - Phone:415-440-4151
Mailing Address - Fax:415-440-4142
Practice Address - Street 1:2211 BUSH ST 100
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3121
Practice Address - Country:US
Practice Address - Phone:415-440-4151
Practice Address - Fax:415-440-4142
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00931630OtherMEDICARE RAILROAD
ILP00684873OtherRAILROAD MEDICARE
ILP00684873OtherRAILROAD MEDICARE
ILK36674Medicare PIN