1831386838 NPI number — STITHEM & JOHNSON PHYSICAL THERAPY INC.

Table of content: (NPI 1831386838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831386838 NPI number — STITHEM & JOHNSON PHYSICAL THERAPY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STITHEM & JOHNSON 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:
6
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:
1831386838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
795 FARMERS LN
Provider Second Line Business Mailing Address:
STE 10
Provider Business Mailing Address City Name:
SANTA ROSA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95405-6718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-571-7615
Provider Business Mailing Address Fax Number:
707-571-8601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6574 OAKMONT DR
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95409-5958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-539-5256
Provider Business Practice Location Address Fax Number:
707-539-7914
Provider Enumeration Date:
10/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NEWHALL
Authorized Official First Name:
MEGAN
Authorized Official Middle Name:
SIERRA
Authorized Official Title or Position:
CLINIC ADMINISTRATOR
Authorized Official Telephone Number:
707-571-7615

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DA6103 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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