Provider Demographics
NPI:1427249218
Name:HARSUVANAKIT, IMEE (DPT)
Entity type:Individual
Prefix:
First Name:IMEE
Middle Name:
Last Name:HARSUVANAKIT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1588 20TH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3440
Mailing Address - Country:US
Mailing Address - Phone:732-331-4809
Mailing Address - Fax:
Practice Address - Street 1:247 SHORELINE HWY
Practice Address - Street 2:STE A9
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3664
Practice Address - Country:US
Practice Address - Phone:415-381-8707
Practice Address - Fax:415-634-3066
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056726OtherMEDICARE