Healthcare Provider Details

I. General information

NPI: 1548442882
Provider Name (Legal Business Name): MR. GARRETT JOESPH ELSBERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 CHALLENGER WAY STE 107
SANTA ROSA CA
95407-5423
US

IV. Provider business mailing address

2255 CHALLENGER WAY STE 107
SANTA ROSA CA
95407-5423
US

V. Phone/Fax

Practice location:
  • Phone: 707-867-3755
  • Fax:
Mailing address:
  • Phone: 707-867-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: