Provider Demographics
NPI:1447996137
Name:WEST MARIN PHYSICAL THERAPY
Entity type:Organization
Organization Name:WEST MARIN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:FREDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEITZER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:415-663-9216
Mailing Address - Street 1:PO BOX 1264
Mailing Address - Street 2:
Mailing Address - City:POINT REYES STATION
Mailing Address - State:CA
Mailing Address - Zip Code:94956-1264
Mailing Address - Country:US
Mailing Address - Phone:415-663-9216
Mailing Address - Fax:415-663-9216
Practice Address - Street 1:11431 STATE ROUTE 1
Practice Address - Street 2:SUITE 9
Practice Address - City:POINT REYES STATION
Practice Address - State:CA
Practice Address - Zip Code:94956-1264
Practice Address - Country:US
Practice Address - Phone:415-663-9216
Practice Address - Fax:415-663-9216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy