NPIMap

Organization Active NPI

Marin Physical Therapy, Inc.

  • Specialist
  • San Rafael, CA
National Provider Identifier
1275658148
Registry record updated Apr 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
PT15707 Issued in CA
Legal business name
MARIN PHYSICAL THERAPY, INC.
Practice address
165 N Redwood Dr
Suite #120
San Rafael, CA 94903-1969
Phone
(415) 499-0278
NPI assigned
Mar 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Andrew Edward Kelly, P.T.
Title
Owner
Phone
(415) 499-0278

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X PT15707 CA Primary

Addresses

Primary practice location

165 N Redwood Dr
Suite #120
San Rafael, CA 94903-1969

Mailing address

165 North Redwood Drive
Suite #120
San Rafael, CA 94903
Phone (415) 499-0278

National Provider Directory

National Provider Directory

Locations

165 N Redwood Dr
Ste 120
San Rafael, CA 94903
Phone (415) 499-0278

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207008000000",
    "number": "1275658148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 NORTH REDWOOD DRIVE",
            "address_2": "SUITE #120",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "94903",
            "telephone_number": "415-499-0278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 N REDWOOD DR",
            "address_2": "SUITE #120",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949031969",
            "telephone_number": "415-499-0278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2008-04-01",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "415-499-0278",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "PT15707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.