Healthcare Provider Details

I. General information

NPI: 1407793607
Provider Name (Legal Business Name): ANALISA E RAGUSA PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 DEL GANADO RD
SAN RAFAEL CA
94903-2395
US

IV. Provider business mailing address

2021 YGNACIO VALLEY RD STE C202
WALNUT CREEK CA
94598-3392
US

V. Phone/Fax

Practice location:
  • Phone: 415-479-2545
  • Fax:
Mailing address:
  • Phone: 925-945-1474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number308719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: