Healthcare Provider Details

I. General information

NPI: 1902964117
Provider Name (Legal Business Name): CALIENTE SPRINGS PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17350 VAILETTI DR
SONOMA CA
95476-3356
US

IV. Provider business mailing address

17350 VAILETTI DR
SONOMA CA
95476-3356
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 TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. GINA MARIE GUZMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 707-935-3230