Organization
FORM PHYSICAL THERAPY, A PROFESSIONAL CORPORATION
Active
Other names
Form Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACEE LEE BROWN PT, DPT, ATC (OWNER/PRESIDENT)
(415) 297-4113
Entity
Organization
Contact information
Practice address
2358 PINE STREET, SAN FRANCISCO, CA 94115
(415) 297-4113
(415) 684-7694
Mailing address
68 DOMINICAN DRIVE, SAN RAFAEL, CA 94901
(415) 297-4113
(415) 684-7694
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
29589
CA
Other
Enumeration date
08/26/2008
Last updated
09/06/2012
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