Organization
COTATI ROHNERT PARK PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IDEN WARNOCK PT (PHYSICALTHERAPIST)
(707) 795-1636
Entity
Organization
Contact information
Practice address
7840 OLD REDWOOD HWY, COTATI, CA 94931
(707) 795-1636
(707) 795-2273
Mailing address
7840 OLD REDWOOD HWY, COTATI, CA 94931-5106
(707) 795-1636
(707) 795-2273
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
PT8789
CA
2251S0007X
Sports Physical Therapist
PT8789
CA
2251X0800X
Orthopedic Physical Therapist
Primary
PT8789
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00PT87890
—
CA
Enumeration date
06/11/2008
Last updated
05/27/2019
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