Active NPI
Aquatic Therapy Associates
- Physical Therapist
- San Rafael, CA
National Provider Identifier
1972632172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT16863
- Legal business name
- AQUATIC THERAPY ASSOCIATES
- Practice address
- 200 N San Pedro Rd
San Rafael, CA 94903-4213 - Phone
- (415) 507-9800
- NPI assigned
- Mar 5, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Caryl Sircus
- Title
- Executive Director
- Phone
- (415) 507-9800
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT16863 | CA | Primary |
Addresses
Primary practice location
200 N San Pedro Rd
San Rafael, CA 94903-4213
Mailing address
4460 16 Redwood Hwy #404
San Rafael, CA 94903
National Provider Directory
National Provider DirectoryLocations
4460 Redwood Hwy
#404
San Rafael, CA 94903
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1972632172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4460 16 REDWOOD HWY #404",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "94903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 N SAN PEDRO RD",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949034213",
"telephone_number": "415-507-9800"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AQUATIC THERAPY ASSOCIATES",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-05",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "SIRCUS",
"authorized_official_first_name": "CARYL",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "415-507-9800"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT16863",
"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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.