MEDICARE: SONOMA HILLS PHYSICAL THERAPY

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	PT11153	CA

General Provider Information

NPI Number	:	1518090083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONOMA HILLS PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	159 LYNCH CREEK WAY
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94954-2342
Country	:	US
Telephone Number	:	707-763-2340
Fax Number	:

Provider Business Practice Location Address
First Line	:	159 LYNCH CREEK WAY
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94954-2342
Country	:	US
Telephone Number	:	707-763-2340
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MRS. ALAKNANDA DEVASKAR
Credential	:
Telephone Number	:	707-763-2340

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	05/01/2014

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