Provider Demographics
NPI:1487800942
Name:MARIN SPORT AND SPINE PHYSICAL THERAPY
Entity type:Organization
Organization Name:MARIN SPORT AND SPINE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:415-614-0590
Mailing Address - Street 1:3727 BUCHANAN ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-5410
Mailing Address - Country:US
Mailing Address - Phone:415-614-0590
Mailing Address - Fax:415-593-7974
Practice Address - Street 1:810 COLLEGE AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-2532
Practice Address - Country:US
Practice Address - Phone:415-614-0590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN FRANCISCO SPORT AND SPINE PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty