Provider Demographics
NPI:1932865243
Name:HALF MOON BAY PHYSICAL THERAPY CORP.
Entity type:Organization
Organization Name:HALF MOON BAY PHYSICAL THERAPY CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:650-440-4717
Mailing Address - Street 1:604 MAIN ST STE J
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1982
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:604 MAIN ST.
Practice Address - Street 2:SUITE J
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019
Practice Address - Country:US
Practice Address - Phone:650-440-4717
Practice Address - Fax:650-440-4736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty