Provider Demographics
NPI:1154499259
Name:PHYSIOTHERAPY ASSOCIATES
Entity Type:Organization
Organization Name:PHYSIOTHERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:YONTS
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:707-584-3433
Mailing Address - Street 1:1331 MEDICAL CENTER DR STE B
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2900
Mailing Address - Country:US
Mailing Address - Phone:707-584-3433
Mailing Address - Fax:707-584-1224
Practice Address - Street 1:1331 MEDICAL CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2900
Practice Address - Country:US
Practice Address - Phone:707-584-3433
Practice Address - Fax:707-584-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT2309174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056831Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER