MEDICARE: JONATHAN R SANBURG PT

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		CA

General Provider Information

NPI Number	:	1710657044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN R SANBURG PT

Provider Business Mailing Address
First Line	:	4990 HILLSDALE CIR STE 100
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-5770
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6710 FOLSOM BLVD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-4626
Country	:	US
Telephone Number	:	916-905-6378
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2021
Last Update Date	:	09/17/2021

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