Healthcare Provider Details

I. General information

NPI: 1124192968
Provider Name (Legal Business Name): ANDRA MAYA SAXE MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 E BIDWELL ST STE 160
FOLSOM CA
95630-6446
US

IV. Provider business mailing address

2575 E BIDWELL ST STE 160
FOLSOM CA
95630-6446
US

V. Phone/Fax

Practice location:
  • Phone: 916-932-1210
  • Fax:
Mailing address:
  • Phone: 916-932-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT24713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: