Individual provider Active NPI

Jeannette Elaine Grace, P.T.

  • Orthopedic Physical Therapist
  • Santa Rosa, CA
National Provider Identifier
1114903192
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
PT21833 Issued in CA
Practice address
795 Farmers LN
Suite 10
Santa Rosa, CA 95405-6718
Phone
(707) 571-7615
Fax
(707) 571-8601
NPI assigned
Dec 21, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X PT21833 CA Primary

Addresses

Primary practice location

795 Farmers LN
Suite 10
Santa Rosa, CA 95405-6718

Mailing address

795 Farmers LN
Suite 10
Santa Rosa, CA 95405-6718
Phone (707) 571-7615

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070928000666 CA Practitioner - Physical Therapist in Private Practice 9739274291 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stac Physical Therapy Sonoma IncGroup PAC ID 6002261088, 4 clinicians

Practice addresses (Care Compare)

1400 N Dutton Ave
Suite 1
Santa Rosa, CA 95401-7120
Phone (707) 523-2848

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
PT21833CAMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Stithem & Johnson Physical Therapy Inc. Orthopedic Past Accepting new patients
Stithem & Johnson Physical Therapy, Inc. Orthopedic Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1114903192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "795 FARMERS LN",
            "address_2": "SUITE 10",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954056718",
            "telephone_number": "707-571-7615",
            "fax_number": "707-571-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "795 FARMERS LN",
            "address_2": "SUITE 10",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954056718",
            "telephone_number": "707-571-7615",
            "fax_number": "707-571-8601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRACE",
        "first_name": "JEANNETTE",
        "middle_name": "ELAINE",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-21",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "PT21833",
            "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 Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.