Organization
PACIFIC THERX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA D GREEN PT (OWNER)
(650) 851-1145
Entity
Organization
Contact information
Practice address
150 PORTOLA RD, SUITE B, PORTOLA VALLEY, CA 94028-7852
(530) 417-7505
Mailing address
150 PORTOLA RD, SUITE B, PORTOLA VALLEY, CA 94028-7852
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
291827
CA
Other
Enumeration date
09/22/2016
Last updated
09/22/2016
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