Healthcare Provider Details

I. General information

NPI: 1366499089
Provider Name (Legal Business Name): ANN CATHERINE SABINE P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 ROWLAND WAY
NOVATO CA
94945-5038
US

IV. Provider business mailing address

1550 MATANZAS RD
SANTA ROSA CA
95405-6914
US

V. Phone/Fax

Practice location:
  • Phone: 415-898-1311
  • Fax:
Mailing address:
  • Phone: 707-575-6863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT3912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: