Provider Demographics
NPI:1497048979
Name:REDWOOD PEDIATRIC THERAPY ASSOCIATES INC
Entity Type:Organization
Organization Name:REDWOOD PEDIATRIC THERAPY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:704-546-9160
Mailing Address - Street 1:340 TESCONI CIR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4676
Mailing Address - Country:US
Mailing Address - Phone:707-546-9160
Mailing Address - Fax:707-546-1338
Practice Address - Street 1:340 TESCONI CIR
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4676
Practice Address - Country:US
Practice Address - Phone:707-546-9160
Practice Address - Fax:707-546-1338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty