Marin Individual Practice Association

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

041525 Issued in CA

Legal business name

MARIN INDIVIDUAL PRACTICE ASSOCIATION

Practice address

1401 Los Gamos Drive
Suite 140
San Rafael, CA 94903

Phone

(415) 479-7100

Fax

(415) 479-7137

NPI assigned

Jul 12, 2006

Organization subpart

Yes

Parent organization

MARIN INDIVIDUAL PRACTICE ASSOCIATIONAs reported in NPPES

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

Authorized official

Name

Wojtek Nowak

Title

Chief Executive Officer

Phone

(415) 884-1818

Specialties & licenses 1

Addresses

Other names 1

• DBA: Core Physical Therapy, DBA: Meritage Medical Network Doing business as

Part of

Marin Ipa

Locations

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522022400000",
    "number": "1528093093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 LOS GAMOS DRIVE",
            "address_2": "SUITE 140",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "94903",
            "telephone_number": "415-479-7100",
            "fax_number": "415-479-7137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 LOS GAMOS DRIVE",
            "address_2": "SUITE 140",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "94903",
            "telephone_number": "415-479-7100",
            "fax_number": "415-479-7137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN INDIVIDUAL PRACTICE ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARIN INDIVIDUAL PRACTICE ASSOCIATION",
        "enumeration_date": "2006-07-12",
        "last_updated": "2018-03-26",
        "status": "A",
        "authorized_official_last_name": "NOWAK",
        "authorized_official_first_name": "WOJTEK",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "415-884-1818"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "041525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA: Core Physical Therapy, DBA: Meritage Medical Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marin Health Ventures, LLC
• Marin Healthcare District
• Marin Hills Medical Group Inc
• Marin Home Care Inc
• Marin Housing Authority
• Marin Naturopathic Medicine
• Marin Neuropsychology and Psychological Center, PC
• Marin Neuropsychology Center - a Psychology Corporation
• Marin Ophthalmic Consultants, a Medical Corporation
• Marin Ophthalmic Gallary

• Physical Therapy Clinic/Center in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Physical Therapy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2018; 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.