Provider Demographics
NPI:1912530114
Name:STANIULYTE, RASA
Entity Type:Individual
Prefix:
First Name:RASA
Middle Name:
Last Name:STANIULYTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 SHAKESPEARE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3938
Mailing Address - Country:US
Mailing Address - Phone:773-943-1867
Mailing Address - Fax:
Practice Address - Street 1:1489 WEBSTER ST STE 210
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3760
Practice Address - Country:US
Practice Address - Phone:415-346-8373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-15
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT298042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist