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Organization
ESSENTIAL BALANCE PHYSICAL THERAPY, INC
Active
Organization
ESSENTIAL BALANCE PHYSICAL THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BONNIE JEAN DAVIDSON PT (OWNER/TREASURER)
(415) 924-5700
Entity
Organization
Contact information
Practice address
25 MITCHELL BLVD, SUITE 2, SAN RAFAEL, CA 94903-2007
(415) 924-5700
(415) 924-5723
Mailing address
25 MITCHELL BLVD, SUITE 2, SAN RAFAEL, CA 94903-2007
(415) 924-5700
(415) 924-5723
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1205886561
NPI
CA
01
—
1609826965
NPI
CA
Enumeration date
05/20/2006
Last updated
12/05/2017
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