Provider Demographics
NPI:1134167885
Name:PELTZ, AARON (DPT)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:PELTZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WIKIUP DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1375
Mailing Address - Country:US
Mailing Address - Phone:707-542-5400
Mailing Address - Fax:707-542-5401
Practice Address - Street 1:101 WIKIUP DR
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1375
Practice Address - Country:US
Practice Address - Phone:707-542-5400
Practice Address - Fax:707-542-5401
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 28597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT285970OtherBLUE SHIELD ID NUMBER
CA0PT285970Medicare ID - Type UnspecifiedMEDICARE PERSONAL ID