Provider Demographics
NPI:1194890517
Name:MARANTZ, MINDY SUE (PT)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:SUE
Last Name:MARANTZ
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 1:1200 GOUGH ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-6649
Mailing Address - Country:US
Mailing Address - Phone:415-921-1211
Mailing Address - Fax:415-921-1229
Practice Address - Street 1:1200 GOUGH ST
Practice Address - Street 2:SUITE 700
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6649
Practice Address - Country:US
Practice Address - Phone:415-921-1211
Practice Address - Fax:415-921-1229
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA11642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist