NPIMap

Organization Active NPI

Mindful Physical Therapy

  • Physical Therapy Clinic/Center
  • Kentfield, CA
National Provider Identifier
1780935411
Registry record updated Jan 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT24068 Issued in CA
Legal business name
MINDFUL PHYSICAL THERAPY
Practice address
901 Sir Francis Drake Blvd
Suite B
Kentfield, CA 94904-1502
Phone
(415) 256-9990
Fax
(415) 256-9991
NPI assigned
Sep 20, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2013

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

Authorized official

Name
Mr. David John Borgeson, MPT, MSNPI 1013268754
Title
President
Phone
(415) 256-9990

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X PT24068 CA Primary

Addresses

Primary practice location

901 Sir Francis Drake Blvd
Suite B
Kentfield, CA 94904-1502

Mailing address

901 Sir Francis Drake Blvd
Suite B
Kentfield, CA 94904-1502
Phone (415) 256-9990

Other identifiers 1

IdentifierTypeStateIssuer
C3455707OtherCACALIFORNIA CORPORATION NUMBER/S-CORP ENTITY ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1348099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357516800000",
    "number": "1780935411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 SIR FRANCIS DRAKE BLVD",
            "address_2": "SUITE B",
            "city": "KENTFIELD",
            "state": "CA",
            "postal_code": "949041502",
            "telephone_number": "415-256-9990",
            "fax_number": "415-256-9991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 SIR FRANCIS DRAKE BLVD",
            "address_2": "SUITE B",
            "city": "KENTFIELD",
            "state": "CA",
            "postal_code": "949041502",
            "telephone_number": "415-256-9990",
            "fax_number": "415-256-9991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-20",
        "last_updated": "2013-01-07",
        "status": "A",
        "authorized_official_last_name": "BORGESON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "415-256-9990",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT, MS"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "PT24068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA CORPORATION NUMBER/S-CORP ENTITY ID",
            "identifier": "C3455707",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kentfield, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2013; 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.