Organization
PROACTIVE THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES LOVEALL YOUNG (EXECUTIVE DIRECTOR)
(415) 346-8373
Entity
Organization
Contact information
Practice address
1489 WEBSTER ST, SUITE 210, SAN FRANCISCO, CA 94115-3766
(415) 346-8373
(415) 346-0806
Mailing address
1489 WEBSTER ST, SUITE 210, SAN FRANCISCO, CA 94115-3766
(415) 346-8373
(415) 346-0806
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
38432480
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ29485Z
BLUE SHIELD
CA
Enumeration date
08/05/2006
Last updated
03/14/2008
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