Sport & Spine Therapy of Marin Inc
Organization Active NPI Orthopedic Physical Therapist · Petaluma, CA
NPI 1861852964 · NPPES record last updated Oct 8, 2020
Key facts
- NPI
- 1861852964
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopedic Physical Therapist 2251X0800X
- Legal business name
- SPORT & SPINE THERAPY OF MARIN INC
- Practice address
- 719 Southpoint Blvd
Suite a
Petaluma, CA 94954-1495 - Phone
- (707) 981-8062
- Fax
- (707) 981-8684
- NPI assigned
- Mar 2, 2016
- Organization subpart
- No
Authorized official
- Name
- Steven Thompson
- Title
- Owner/Ceo
- Phone
- (415) 898-1311
Other NPIs on the same Medicare enrollment 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060710000148 | CA | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 4981617180 |
Receives reassigned benefits from 26 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: San Anselmo, CA; Novato, CA |
National Provider Directory
Locations
719 Southpoint Blvd
Ste A
Petaluma, CA 94954
Phone (707) 781-8062
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Physical Therapist |
2251X0800X | Yes |
Addresses
Primary practice location
719 Southpoint Blvd
Suite a
Petaluma, CA 94954-1495
Mailing address
PO Box 950
Novato, CA 94948-0950
Other providers in Petaluma, CA
- Jennifer Kathryn Spengler
- Lewis Spengler
- Riley Spindler
- Samantha Sidney Spinner
- Hilary Spolini
- Elizabeth Spranger
- SRM Alliance Hospital Services
- St Jude Hospital Yorba Linda
- St Jude Hospital Yorba Linda
- St. Joseph Home Care Network
All providers in Petaluma, CA · Orthopedic Physical Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.