Provider Demographics
NPI:1982689675
Name:STITHEM & JOHNSON PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:STITHEM & JOHNSON PHYSICAL THERAPY, INC.
Other - Org Name:ORTHOPAEDIC AND SPORTS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:SIERRA
Authorized Official - Last Name:NEWHALL
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:707-571-7615
Mailing Address - Street 1:795 FARMERS LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6718
Mailing Address - Country:US
Mailing Address - Phone:707-571-7615
Mailing Address - Fax:707-571-8601
Practice Address - Street 1:795 FARMERS LN
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6718
Practice Address - Country:US
Practice Address - Phone:707-571-7615
Practice Address - Fax:707-571-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA6103OtherRAILROAD MEDICARE PTAN
CADA6103OtherRAILROAD MEDICARE PTAN