Healthcare Provider Details

I. General information

NPI: 1245149194
Provider Name (Legal Business Name): STAC PHYSICAL THERAPY FAMILY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3736 ATHERTON RD STE 100
ROCKLIN CA
95765-3814
US

IV. Provider business mailing address

3736 ATHERTON RD STE 100
ROCKLIN CA
95765-3814
US

V. Phone/Fax

Practice location:
  • Phone: 916-782-7848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: OR NATIV
Title or Position: OWNER
Credential: PT
Phone: 510-653-5151