1033289509 NPI number — SANNA PHYSICAL THERAPY INC

Table of content: CAITLIN RENEE RILEY DPT (NPI 1396171146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033289509 NPI number — SANNA PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANNA PHYSICAL THERAPY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033289509
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7539 SOQUEL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APTOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95003-3815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-688-1332
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7539 SOQUEL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APTOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95003-3815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-688-1332
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANNA
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PHYSICAL THERAPIST OWNER
Authorized Official Telephone Number:
831-688-1332

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT13063 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C2233505 . This is a "CORPORATE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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