Keith Lauren Pullin, P.T., D.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

39222 Issued in CA

Practice address

101 Wikiup Dr Ste B
Santa Rosa, CA 95403-1375

Phone

(707) 542-5400

NPI assigned

Jul 23, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Peltz and Associates Physical Therapy Inc

  • Physical Therapy Clinic/Center
  • Santa Rosa, CA
  • NPI 1356389001

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1343001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1295080588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 WIKIUP DR STE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031375",
            "telephone_number": "707-542-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 WIKIUP DR STE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031375",
            "telephone_number": "707-542-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PULLIN",
        "first_name": "KEITH",
        "middle_name": "LAUREN",
        "credential": "P.T., D.P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-23",
        "last_updated": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "39222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1400 Veterans Blvd",
            "city": "Redwood City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "940632612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Josie Puett
• Saul Pulido-Torres, MASSAGE THERAPIST
• Daisy Pulido
• Julisa Irene Pulido
• George James Pulis, M.A.
• Harendra Keshavlal Punatar, M.D.
• Pura Vida Recovery Services, LLC (Pura Vida Recovery Services)
• Pura Vida Recovery Services, LLC (Pura Vida Recovery Services)
• Pura Vida Recovery Services, LLC (Pura Vida Recovery Services)
• Pura Vida Recovery Services, LLC

• Physical Therapist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.