Provider Demographics
NPI:1659445443
Name:AGILE PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:AGILE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-565-8090
Mailing Address - Street 1:2450 EL CAMINO REAL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1706
Mailing Address - Country:US
Mailing Address - Phone:650-565-8090
Mailing Address - Fax:650-565-8095
Practice Address - Street 1:2450 EL CAMINO REAL
Practice Address - Street 2:SUITE 101
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1706
Practice Address - Country:US
Practice Address - Phone:650-565-8090
Practice Address - Fax:650-565-8095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17712261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy