Provider Demographics
NPI:1801982905
Name:SPORTS THERAPY ASSOCIATES INC
Entity type:Organization
Organization Name:SPORTS THERAPY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:MUTTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:650-692-5633
Mailing Address - Street 1:1545 OLD BAYSHORE HWY
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1602
Mailing Address - Country:US
Mailing Address - Phone:650-692-5633
Mailing Address - Fax:650-692-8497
Practice Address - Street 1:1545 BAYSHORE HWY
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1602
Practice Address - Country:US
Practice Address - Phone:650-692-5633
Practice Address - Fax:650-692-8497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty