Provider Demographics
NPI:1639316631
Name:PENDLETON, GILLIAN M (PT)
Entity Type:Individual
Prefix:MS
First Name:GILLIAN
Middle Name:M
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:GILLIAN
Other - Middle Name:M
Other - Last Name:RIVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1400 NORTH DUTTON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-7120
Mailing Address - Country:US
Mailing Address - Phone:707-523-2848
Mailing Address - Fax:707-523-2866
Practice Address - Street 1:100 PLEASANT HILL AVE N
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3104
Practice Address - Country:US
Practice Address - Phone:707-829-3282
Practice Address - Fax:707-829-3287
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10715225100000X
HI2969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist