Provider Demographics
NPI:1831386838
Name:STITHEM & JOHNSON PHYSICAL THERAPY INC.
Entity type:Organization
Organization Name:STITHEM & JOHNSON PHYSICAL THERAPY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MS
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:STE 10
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 1:6574 OAKMONT DR
Practice Address - Street 2:STE A
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-5958
Practice Address - Country:US
Practice Address - Phone:707-539-5256
Practice Address - Fax:707-539-7914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2013-08-14
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