Provider Demographics
NPI:1174055073
Name:MISSION DISTRICT PHYSICAL THERAPY & REHABILITATION
Entity type:Organization
Organization Name:MISSION DISTRICT PHYSICAL THERAPY & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:HUGO
Authorized Official - Last Name:CAIMANQUE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:415-824-4228
Mailing Address - Street 1:3490 20TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2582
Mailing Address - Country:US
Mailing Address - Phone:415-824-4228
Mailing Address - Fax:415-824-4678
Practice Address - Street 1:3490 20TH ST FL 1
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2582
Practice Address - Country:US
Practice Address - Phone:415-824-4228
Practice Address - Fax:415-824-4678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16150261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB9323545OtherCALIFORNIA DRIVERS LICENSE