Provider Demographics
NPI:1568504157
Name:SANOCKI, COLEEN ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:COLEEN
Middle Name:ANN
Last Name:SANOCKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 EL CAMINO REAL STE 210
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1531
Mailing Address - Country:US
Mailing Address - Phone:650-559-0011
Mailing Address - Fax:650-559-0012
Practice Address - Street 1:5050 EL CAMINO REAL STE 210
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1531
Practice Address - Country:US
Practice Address - Phone:650-559-0011
Practice Address - Fax:650-559-0012
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist