Healthcare Provider Details

I. General information

NPI: 1972859528
Provider Name (Legal Business Name): CAROL KRAUTHAMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL KRZYWICKI PT

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17350 VAILETTI DR
SONOMA CA
95476-3356
US

IV. Provider business mailing address

PO BOX 1852
SONOMA CA
95476-1852
US

V. Phone/Fax

Practice location:
  • Phone: 707-935-3230
  • Fax: 707-935-8481
Mailing address:
  • Phone: 707-935-3230
  • Fax: 707-935-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT9702
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: