NPIMap

Organization Active NPI

Stac Physical Therapy Sonoma, Inc.

  • Physical Therapist
  • Santa Rosa, CA
National Provider Identifier
1720707136
Registry record updated Aug 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
STAC PHYSICAL THERAPY SONOMA, INC.
Practice address
1400 N Dutton Ave Ste 1
Santa Rosa, CA 95401-7120
Phone
(707) 523-2848
Fax
(707) 523-2866
NPI assigned
Aug 26, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2022

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

Authorized official

Name
Andra Colman, PTNPI 1639407307
Title
Owner
Phone
(714) 904-2703

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

1400 N Dutton Ave Ste 1
Santa Rosa, CA 95401-7120

Mailing address

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

Other names 1

  • North Santa Rosa Physical Therapy Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Raintree Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251216002103 CA Part B Supplier - Clinic/Group Practice 6002261088 Receives reassigned benefits from 6 practitioners
Practice locations: Santa Rosa, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1661472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661472000000",
    "number": "1720707136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 N DUTTON AVE STE 1",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954017120",
            "telephone_number": "707-523-2848",
            "fax_number": "707-523-2866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 N DUTTON AVE STE 1",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954017120",
            "telephone_number": "707-523-2848",
            "fax_number": "707-523-2866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAC PHYSICAL THERAPY SONOMA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-26",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A",
        "authorized_official_last_name": "COLMAN",
        "authorized_official_first_name": "ANDRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-904-2703",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Raintree",
            "affiliation": "N",
            "endpointDescription": "EMR system",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1400 N Dutton Ave Ste 1",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954017120",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "North Santa Rosa Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 26, 2022; 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.