Healthcare Provider Details

I. General information

NPI: 1831386838
Provider Name (Legal Business Name): STITHEM & JOHNSON PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6574 OAKMONT DR STE A
SANTA ROSA CA
95409-5958
US

IV. Provider business mailing address

795 FARMERS LN STE 10
SANTA ROSA CA
95405-6718
US

V. Phone/Fax

Practice location:
  • Phone: 707-539-5256
  • Fax: 707-539-7914
Mailing address:
  • Phone: 707-571-7615
  • Fax: 707-571-8601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MEGAN SIERRA NEWHALL
Title or Position: CLINIC ADMINISTRATOR
Credential: BA
Phone: 707-571-7615