Provider Demographics
NPI:1306322094
Name:PHYSICAL THERAPT
Entity type:Organization
Organization Name:PHYSICAL THERAPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT, SCS
Authorized Official - Phone:415-529-8077
Mailing Address - Street 1:290 DIVISION ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-4892
Mailing Address - Country:US
Mailing Address - Phone:415-529-8077
Mailing Address - Fax:415-869-2870
Practice Address - Street 1:290 DIVISION ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-4892
Practice Address - Country:US
Practice Address - Phone:415-529-8077
Practice Address - Fax:415-869-2870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty