Healthcare Provider Details

I. General information

NPI: 1851506547
Provider Name (Legal Business Name): ANNA YEMIZ MITSUNAGA PT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CONCOURSE BLVD
SANTA ROSA CA
95403-8210
US

IV. Provider business mailing address

220 CONCOURSE BLVD
SANTA ROSA CA
95403-8210
US

V. Phone/Fax

Practice location:
  • Phone: 844-527-7369
  • Fax: 844-847-4943
Mailing address:
  • Phone: 844-527-7369
  • Fax: 844-847-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number29893
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number29893
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number29893
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: