| Backtogolf Performance & Fitness Inc | |
|
208 Concourse Blvd, Santa Rosa, CA 95403 | |
| (707) 303-4992 | |
| (707) 303-4996 |
| Full Name | Backtogolf Performance & Fitness Inc |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 208 Concourse Blvd, Santa Rosa, California |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669571188 | NPI | - | NPPES |
| DB6552 | Other | RAILROAD MEDICARE GRP # | |
| ZZZ00793Z | Other | CA | BLUE SHIELD GRP ID |
| P00120133 | Other | RAILROAD MEDICARE (PIN) | |
| 105079200 | Other | CA | US DEPT OF LABOR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | PT11380 (California) | Primary |
| Provider Name | Mark L Archambault |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1174628333 PECOS PAC ID: 6406801844 Enrollment ID: I20111118000353 |
| Provider Name | Jeffrey D Latz |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1497850598 PECOS PAC ID: 6507030558 Enrollment ID: I20111201000191 |
| Provider Name | Melissa Klein |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1154662088 PECOS PAC ID: 3779722715 Enrollment ID: I20130624000064 |
| Provider Name | Paige E Perez |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1811515786 PECOS PAC ID: 7719399930 Enrollment ID: I20210702002436 |
| Provider Name | Louis Venditti |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1588302061 PECOS PAC ID: 2062893506 Enrollment ID: I20240208004028 |
| Mailing Address | Practice Location Address |
|---|---|
| Backtogolf Performance & Fitness Inc Po Box 10, Suite 2, Windsor, CA 95492 Ph: (707) 303-4992 | Backtogolf Performance & Fitness Inc 208 Concourse Blvd, Santa Rosa, CA 95403 Ph: (707) 303-4992 |
Nicholas Pasadis, Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1400 N Dutton Ave Ste 1, Santa Rosa, CA 95401 Phone: 707-523-2848 | |
Ms. Deborah Mary Stewart, BSPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 181 Leisure Park Cir, Santa Rosa, CA 95401 Phone: 707-695-5008 | |
Kurt Falkenberg, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 401 Bicentennial Way, East Building, Suite 190, Santa Rosa, CA 95403 Phone: 707-571-3352 | |
Patrick K Kam, RPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 2798 Yulupa Ave, #1, Santa Rosa, CA 95405 Phone: 707-527-4001 | |
Ms. Rhodan Vignaud, PHYSICAL THERAPIST Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 3559 Round Barn Circle, Kaiser Permanente, Santa Rosa, CA 95403 Phone: 707-571-3921 | |
Dr. Christina Leisen, P.T., D.P.T. Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 532 Sonoma Ave Apt A, Santa Rosa, CA 95401 Phone: 707-217-9157 | |
Jeffrey Peter Franceschi, MS PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 2448 Guerneville Rd, Suite 300, Santa Rosa, CA 95403 Phone: 707-573-8202 Fax: 707-573-8204 |