Provider Demographics
NPI:1356389001
Name:PELTZ AND ASSOCIATES PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:PELTZ AND ASSOCIATES PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:P
Authorized Official - Last Name:PELTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:707-542-5400
Mailing Address - Street 1:140 WIKIUP DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403
Mailing Address - Country:US
Mailing Address - Phone:707-542-5400
Mailing Address - Fax:707-542-5401
Practice Address - Street 1:140 WIKIUP DRIVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:707-542-5400
Practice Address - Fax:707-542-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13421ZOtherBLUE SHIELD GROUP NUMBER
CAZZZ13421ZOtherBLUE SHIELD GROUP NUMBER