Provider Demographics
NPI:1780860676
Name:PIVETTI, SONIA BACA (PT)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:BACA
Last Name:PIVETTI
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 1:805 AEROVISTA PL
Mailing Address - Street 2:#201
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7919
Mailing Address - Country:US
Mailing Address - Phone:805-788-0805
Mailing Address - Fax:805-788-0845
Practice Address - Street 1:1067 C ST
Practice Address - Street 2:#110
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-1757
Practice Address - Country:US
Practice Address - Phone:209-745-5802
Practice Address - Fax:209-745-5574
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10995225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT09950Medicare PIN