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General NPI Number Information
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NPI Number | 1306929484
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Entity Type | Individual
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Provider Name | RENE ANDRE MAILLARD P.T.
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 3421 VILLA LN STE A
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City | NAPA
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State | CA
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Zip | 94558-3056
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Country | US
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Telephone | 707-257-4089
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Fax | 707-257-4188
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Provider Business Mailing Address
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Address Line | 1685 E NAPA ST
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City | SONOMA
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State | CA
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Zip | 95476-3834
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Country | US
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Telephone | 707-721-6405
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT24674
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License Number State | CA
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