Healthcare Provider Details

I. General information

NPI: 1134036403
Provider Name (Legal Business Name): SCIFIT PETALUMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 OLD REDWOOD HWY
PETALUMA CA
94954-7112
US

IV. Provider business mailing address

5330 OLD REDWOOD HWY
PETALUMA CA
94954-7112
US

V. Phone/Fax

Practice location:
  • Phone: 707-992-0786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT HUNTINGTON
Title or Position: DIRECTOR OF PHYSICAL THERAPY
Credential:
Phone: 707-992-0786