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General NPI Number Information
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NPI Number | 1497048979
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Entity Type | Organization
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Legal Business Name | REDWOOD PEDIATRIC THERAPY ASSOCIATES INC
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 340 TESCONI CIR SUITE C
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City | SANTA ROSA
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State | CA
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Zip | 95401-4676
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Country | US
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Telephone | 707-546-9160
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Fax | 707-546-1338
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Provider Business Mailing Address
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Address Line | 340 TESCONI CIR SUITE C
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City | SANTA ROSA
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State | CA
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Zip | 95401-4676
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Country | US
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Telephone | 707-546-9160
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Fax | 707-546-1338
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KAREN SMITH
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Credential | OTR/L
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Telephone | 704-546-9160
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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