Healthcare Provider Details

I. General information

NPI: 1184343105
Provider Name (Legal Business Name): VERONICA RENEE MCCARRON PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 TESCONI CIR STE G
SANTA ROSA CA
95401-4611
US

IV. Provider business mailing address

20 ANSON RD
HILLSBOROUGH CA
94010-7226
US

V. Phone/Fax

Practice location:
  • Phone: 707-544-2637
  • Fax:
Mailing address:
  • Phone: 650-521-3307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12890773-2401
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number306763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: