Organization
SIERRA PEDIATRIC THERAPY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRISTINE N. CORN PT, MSPT, DPT (OWNER)
(916) 791-2747
Entity
Organization
Contact information
Practice address
720 SUNRISE AVE, SUITE D110, ROSEVILLE, CA 95661-4516
(916) 791-2747
(916) 791-2189
Mailing address
720 SUNRISE AVE, SUITE D110, ROSEVILLE, CA 95661-4516
(916) 791-2747
(916) 791-2189
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT684
CA
225XF0002X
Feeding, Eating & Swallowing Occupational Therapist
OT7936
CA
225XP0200X
Pediatric Occupational Therapist
OT7936
CA
Other
Enumeration date
08/26/2014
Last updated
11/13/2014
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