Provider Demographics
NPI:1871666974
Name:P.S.M.R.C., LLC
Entity type:Organization
Organization Name:P.S.M.R.C., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAUENBUEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:650-755-8830
Mailing Address - Street 1:2945 JUNIPERO SERRA BLVD
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2549
Mailing Address - Country:US
Mailing Address - Phone:650-755-8830
Mailing Address - Fax:650-755-8147
Practice Address - Street 1:2945 JUNIPERO SERRA BLVD
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2549
Practice Address - Country:US
Practice Address - Phone:650-755-8830
Practice Address - Fax:650-755-8147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGZ817AOtherMEDICARE PTAN