MEDICARE: SANNA PHYSICAL THERAPY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT13063	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C2233505	OTHER	CA	CORPORATE NUMBER

General Provider Information

NPI Number	:	1033289509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANNA PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	7539 SOQUEL DRIVE
Second Line	:
City	:	APTOS
State	:	CA
Zip	:	95003-3815
Country	:	US
Telephone Number	:	831-688-1332
Fax Number	:

Provider Business Practice Location Address
First Line	:	7539 SOQUEL DRIVE
Second Line	:
City	:	APTOS
State	:	CA
Zip	:	95003-3815
Country	:	US
Telephone Number	:	831-688-1332
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST OWNER
Name	:	MS. STACEY LEE SANNA
Credential	:	PT
Telephone Number	:	831-688-1332

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/19/2007

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Directions to “SANNA PHYSICAL THERAPY INC ” Practice Location

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