Active NPI
Jodelyn Teofila Ettlin, PTA
- Physical Therapy Assistant
- Rohnert Park, CA
National Provider Identifier
1508284886
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- AT-9120
- Practice address
- 6174 State Farm Dr
Rohnert Park, CA 94928-2135 - Phone
- (707) 480-7789
- NPI assigned
- Apr 3, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | AT-9120 | CA | Primary |
Addresses
Primary practice location
6174 State Farm Dr
Rohnert Park, CA 94928-2135
Mailing address
1244 De Meo St
Santa Rosa, CA 95407-5924
Phone (707) 480-7789
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT-9120 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1396483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1396483200000",
"number": "1508284886",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1244 DE MEO ST",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954075924",
"telephone_number": "707-480-7789"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6174 STATE FARM DR",
"city": "ROHNERT PARK",
"state": "CA",
"postal_code": "949282135",
"telephone_number": "707-480-7789"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETTLIN",
"first_name": "JODELYN TEOFILA",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-04-03",
"last_updated": "2014-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "AT-9120",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rohnert Park, CA
- Irina O Elliott
- Morgan Nicole England
- Megan Epstein, PPS
- Erick N. Cuenca DMD Inc (Rohnert Park Dental)
- Kim Ngoc Etheart, PHARM.D
- Eye Care Institute, a Medical Corporation
- Eye Care Institute, a Medical Corporation
- Farrell Chiropractic, Inc. (Salud Chiropractic)
- Angelica Farrell, DC
- Romayne Elizabeth Farrell, NP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 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.