NPIMap

Organization Active NPI

Santa Rosa Back Fitness and Physical Therapy Inc

  • Physical Therapist
  • Santa Rosa, CA
National Provider Identifier
1104951342
Registry record updated Jun 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SANTA ROSA BACK FITNESS AND PHYSICAL THERAPY INC
Practice address
2798 Yulupa Ave
Ste 1
Santa Rosa, CA 95405-8570
Phone
(707) 527-4001
NPI assigned
Feb 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Barbara E Plath
Title
Manager
Phone
(707) 527-4001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

2798 Yulupa Ave
Ste 1
Santa Rosa, CA 95405-8570

Mailing address

2798 Yulupa Ave
Ste 1
Santa Rosa, CA 95405-8570
Phone (707) 527-4001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051027000268 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1658398839 Receives reassigned benefits from 10 practitioners
Practice locations: Santa Rosa, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433721600000",
    "number": "1104951342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2798 YULUPA AVE",
            "address_2": "STE 1",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954058570",
            "telephone_number": "707-527-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2798 YULUPA AVE",
            "address_2": "STE 1",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954058570",
            "telephone_number": "707-527-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA ROSA BACK FITNESS AND PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2015-06-08",
        "status": "A",
        "authorized_official_last_name": "PLATH",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "707-527-4001"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.