NPIMap

Organization Active NPI

Petaluma Physical Therapy Associates Inc

Doing business as Petaluma Valley Physical Therapy Center

  • Physical Therapist
  • Petaluma, CA
National Provider Identifier
1306933163
Registry record updated Mar 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT 11310 Issued in CA
Legal business name
PETALUMA PHYSICAL THERAPY ASSOCIATES INC
Doing business as
Petaluma Valley Physical Therapy Center
Practice address
169 Lynch Creek Way
Petaluma, CA 94954-2344
Phone
(707) 763-0115
Fax
(707) 763-2130
NPI assigned
Oct 5, 2006
Last updated
Mar 18, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2014

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

Authorized official

Name
Rick Susick, MS PT ATCNPI 1962599704
Title
President
Phone
(707) 763-0115

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT 11310 CA Primary

Addresses

Primary practice location

169 Lynch Creek Way
Petaluma, CA 94954-2344

Mailing address

169 Lynch Creek Way
Petaluma, CA 94954-2344
Phone (707) 763-0115

Other names 1

  • PETALUMA VALLEY PHYSICAL THERAPY CENTER Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395100800000",
    "number": "1306933163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 LYNCH CREEK WAY",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949542344",
            "telephone_number": "707-763-0115",
            "fax_number": "707-763-2130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 LYNCH CREEK WAY",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949542344",
            "telephone_number": "707-763-0115",
            "fax_number": "707-763-2130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETALUMA PHYSICAL THERAPY ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2014-03-18",
        "status": "A",
        "authorized_official_last_name": "SUSICK",
        "authorized_official_first_name": "RICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-763-0115",
        "authorized_official_credential": "MS PT ATC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT 11310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PETALUMA VALLEY PHYSICAL THERAPY CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petaluma, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2014; 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.