Provider Demographics
NPI:1750409561
Name:PENINSULA HAND THERAPY, INC.
Entity type:Organization
Organization Name:PENINSULA HAND THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER HAND THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR,CHT
Authorized Official - Phone:650-755-6500
Mailing Address - Street 1:2945 JUNIPERO SERRA BLVD
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2549
Mailing Address - Country:US
Mailing Address - Phone:650-755-6500
Mailing Address - Fax:650-755-6565
Practice Address - Street 1:2945 JUNIPERO SERRA BLVD
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2549
Practice Address - Country:US
Practice Address - Phone:650-755-6500
Practice Address - Fax:650-755-6565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3395261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28104ZMedicare ID - Type Unspecified
CA6383030001Medicare NSC