Healthcare Provider Details

I. General information

NPI: 1013844422
Provider Name (Legal Business Name): EVAN BACHELDER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1160 N DUTTON AVE
SANTA ROSA CA
95401-4600
US

IV. Provider business mailing address

830 LOUISA DR
SANTA ROSA CA
95404-2829
US

V. Phone/Fax

Practice location:
  • Phone: 707-541-6258
  • Fax:
Mailing address:
  • Phone: 707-480-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number65917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: