Provider Demographics
NPI:1558451872
Name:TODD SOARES
Entity Type:Organization
Organization Name:TODD SOARES
Other - Org Name:NORTH SANTA ROSA PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOARES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:707-523-2848
Mailing Address - Street 1:1400 N DUTTON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4657
Mailing Address - Country:US
Mailing Address - Phone:707-523-2848
Mailing Address - Fax:707-523-2866
Practice Address - Street 1:1400 N DUTTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4657
Practice Address - Country:US
Practice Address - Phone:707-523-2848
Practice Address - Fax:707-523-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19057ZMedicare PIN