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Organization
PACFIC THERX, INC.
Active
Organization
PACFIC THERX, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA DIANE GREEN MPT, ATC (CEO)
(650) 851-1145
Entity
Organization
Contact information
Practice address
919 FREMONT AVE, SUITE 100, LOS ALTOS, CA 94024-6024
(650) 949-3404
(650) 949-3405
Mailing address
919 FREMONT AVE, SUITE 100, LOS ALTOS, CA 94024-6024
(650) 949-3404
(650) 949-3405
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT18800
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ64064Z
BLUE SHIELD
CA
Enumeration date
04/24/2007
Last updated
08/22/2020
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