Healthcare Provider Details

I. General information

NPI: 1407802614
Provider Name (Legal Business Name): KIMBERLY F AUL MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 OLD REDWOOD HWY MOB 5, SUITE 154
SANTA ROSA CA
95403-1719
US

IV. Provider business mailing address

3975 OLD REDWOOD HWY MOB 5, SUITE 154
SANTA ROSA CA
95403-1719
US

V. Phone/Fax

Practice location:
  • Phone: 707-556-5858
  • Fax: 707-546-1897
Mailing address:
  • Phone: 707-556-5858
  • Fax: 707-546-1897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5073
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT36898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: