Basic Information
| Provider Information | |||||||||
| NPI: | 1154499259 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PHYSIOTHERAPY ASSOCIATES | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1331 MEDICAL CENTER DR STE B | ||||||||
| Address2: | |||||||||
| City: | ROHNERT PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949282900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075843433 | ||||||||
| FaxNumber: | 7075841224 | ||||||||
| Practice Location | |||||||||
| Address1: | 1331 MEDICAL CENTER DR STE B | ||||||||
| Address2: | |||||||||
| City: | ROHNERT PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949282900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075843433 | ||||||||
| FaxNumber: | 7075841224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | YONTS | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | CAROL | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPY ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 7075843433 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | PTA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | AT2309 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.