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General NPI Number Information
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NPI Number | 1518090083
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Entity Type | Organization
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Legal Business Name | SONOMA HILLS PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 05/01/2014
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Provider Practice Location Address
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Address Line | 159 LYNCH CREEK WAY
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City | PETALUMA
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State | CA
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Zip | 94954-2342
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Country | US
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Telephone | 707-763-2340
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Fax |
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Provider Business Mailing Address
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Address Line | 159 LYNCH CREEK WAY
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City | PETALUMA
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State | CA
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Zip | 94954-2342
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Country | US
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Telephone | 707-763-2340
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. ALAKNANDA DEVASKAR
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Credential |
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Telephone | 707-763-2340
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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 | PT11153
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License Number State | CA
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