Provider Demographics
NPI:1174061444
Name:SAUSALITO HEALING ARTS
Entity type:Organization
Organization Name:SAUSALITO HEALING ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARYALICE
Authorized Official - Middle Name:OSHANA
Authorized Official - Last Name:BIONDI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:415-332-6061
Mailing Address - Street 1:85 LIBERTY SHIP WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-3316
Mailing Address - Country:US
Mailing Address - Phone:415-332-6061
Mailing Address - Fax:415-480-1313
Practice Address - Street 1:85 LIBERTY SHIP WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-3316
Practice Address - Country:US
Practice Address - Phone:415-332-6061
Practice Address - Fax:415-480-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty