Provider Demographics
NPI:1487785036
Name:KREGELOH, MARION (PT)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:KREGELOH
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 1:1050 NORTHGATE DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2526
Mailing Address - Country:US
Mailing Address - Phone:415-479-1765
Mailing Address - Fax:415-479-1755
Practice Address - Street 1:1050 NORTHGATE DR
Practice Address - Street 2:SUITE 230
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2526
Practice Address - Country:US
Practice Address - Phone:415-479-1765
Practice Address - Fax:415-479-1755
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA155750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist