Provider Demographics
NPI:1205847084
Name:AMMERMAN, GARIN L (PTA)
Entity Type:Individual
Prefix:
First Name:GARIN
Middle Name:L
Last Name:AMMERMAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:9280 W STOCKTON BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-8073
Practice Address - Country:US
Practice Address - Phone:916-731-7714
Practice Address - Fax:916-731-7871
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT6235225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant