Provider Demographics
NPI:1316930076
Name:BAY AREA SPINE & SPORT, INC
Entity type:Organization
Organization Name:BAY AREA SPINE & SPORT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VERNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:888-208-8526
Mailing Address - Street 1:3444 KEARNY VILLA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1959
Mailing Address - Country:US
Mailing Address - Phone:888-208-8526
Mailing Address - Fax:858-751-0901
Practice Address - Street 1:1801 CLEVELAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4297
Practice Address - Country:US
Practice Address - Phone:707-526-4180
Practice Address - Fax:707-526-4152
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MDRS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-29
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomicsGroup - Multi-Specialty
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, ClinicalGroup - Multi-Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT244770Medicare ID - Type UnspecifiedP DALTON
CAOPT258000Medicare PIN
CAB24978Medicare UPIN
CAOPT246560Medicare ID - Type UnspecifiedK QUINN-DALTON
CAZZZ19066ZMedicare ID - Type UnspecifiedGROUP ID
CAZZZ19066ZMedicare PIN