MEDICARE: AARON PELTZ D.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT 28597	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0PT285970	OTHER	CA	BLUE SHIELD ID NUMBER

General Provider Information

NPI Number	:	1134167885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON PELTZ D.P.T.

Provider Business Mailing Address
First Line	:	101 WIKIUP DR
Second Line	:	SUITE B
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1375
Country	:	US
Telephone Number	:	707-542-5400
Fax Number	:	707-542-5401

Provider Business Practice Location Address
First Line	:	101 WIKIUP DR
Second Line	:	SUITE B
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1375
Country	:	US
Telephone Number	:	707-542-5400
Fax Number	:	707-542-5401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	07/08/2007

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