Provider Demographics
NPI:1285469759
Name:PINNACLE KIDZ PHYSICAL THERAPY
Entity type:Organization
Organization Name:PINNACLE KIDZ PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:ESTELLE
Authorized Official - Last Name:GRADERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-654-5324
Mailing Address - Street 1:1640 VALENCIA ST STE 1C
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-5040
Mailing Address - Country:US
Mailing Address - Phone:415-654-5324
Mailing Address - Fax:415-654-5327
Practice Address - Street 1:1640 VALENCIA ST STE 1C
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-5040
Practice Address - Country:US
Practice Address - Phone:415-654-5324
Practice Address - Fax:415-654-5327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty