Organization
SPORT & SPINE THERAPY OF MARIN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BOBBY ISMAIL DPT (PRESIDENT)
(209) 353-1988
Entity
Organization
Contact information
Practice address
88 ROWLAND WAY, SUITE 250, NOVATO, CA 94945-5042
(415) 898-1311
(415) 897-0741
Mailing address
PO BOX 950, SUITE 250, NOVATO, CA 94948-0950
(415) 898-1311
(415) 897-0741
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BK 875
MEDICARE PTAN
CA
Enumeration date
05/24/2006
Last updated
12/06/2023
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