Provider Demographics
NPI:1093791717
Name:MOHR, GUY STEPHAN (AT)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:STEPHAN
Last Name:MOHR
Suffix:
Gender:M
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 FARMERS LN
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6718
Mailing Address - Country:US
Mailing Address - Phone:707-571-7615
Mailing Address - Fax:707-571-8601
Practice Address - Street 1:795 FARMERS LN
Practice Address - Street 2:SUITE 10
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6718
Practice Address - Country:US
Practice Address - Phone:707-571-7615
Practice Address - Fax:707-571-8601
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT42942251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic