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Organization
PACIFIC THERX, INC.
Active
Organization
PACIFIC THERX, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA DIANE GREEN II MPT, ATC (CEO)
(650) 851-1145
Entity
Organization
Contact information
Practice address
150 PORTOLA RD, SUITE B, PORTOLA VALLEY, CA 94028-7852
(650) 851-1145
(650) 851-9251
Mailing address
150 PORTOLA RD, SUITE B, PORTOLA VALLEY, CA 94028-7852
(650) 851-1145
(650) 851-9251
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT18800
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ60919Z
BLUE SHIELD
CA
Enumeration date
04/17/2007
Last updated
08/22/2020
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