Healthcare Provider Details

I. General information

NPI: 1366383440
Provider Name (Legal Business Name): CLARE THEISEN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MARK WEST SPRINGS RD FL 3
SANTA ROSA CA
95403-1766
US

IV. Provider business mailing address

34 MARK WEST SPRINGS RD STE 200
SANTA ROSA CA
95403-1783
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-8962
  • Fax:
Mailing address:
  • Phone: 707-521-8962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number309607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: