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NPI Code Detail

MEDICARE: STAC PHYSICAL THERAPY SONOMA, INC.

MEDICARE: STAC PHYSICAL THERAPY SONOMA, INC.
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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1720707136
Entity Type Code : Organization
Provider Name (Legal Business Name) : STAC PHYSICAL THERAPY SONOMA, INC.
Provider Business Mailing Address
First Line : 1400 N DUTTON AVE STE 1
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-7120
Country : US
Telephone Number : 707-523-2848
Fax Number : 707-523-2866
Provider Business Practice Location Address
First Line : 1400 N DUTTON AVE STE 1
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-7120
Country : US
Telephone Number : 707-523-2848
Fax Number : 707-523-2866
Authorized Official
Title or Position : OWNER
Name : ANDRA COLMAN
Credential : PT
Telephone Number : 714-904-2703
Provider Enumeration Date : 08/26/2022
Last Update Date : 08/26/2022

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Directions to “STAC PHYSICAL THERAPY SONOMA, INC. ” Practice Location

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