Provider Demographics
NPI:1376953133
Name:SONOMA HILLS PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:SONOMA HILLS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALAKNANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVASKAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:707-763-2340
Mailing Address - Street 1:151 LYNCH CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-2342
Mailing Address - Country:US
Mailing Address - Phone:707-763-2340
Mailing Address - Fax:707-763-3629
Practice Address - Street 1:151 LYNCH CREEK WAY
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2342
Practice Address - Country:US
Practice Address - Phone:707-763-2340
Practice Address - Fax:707-763-3629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT111530OtherMEDICARE PTAN