Provider Demographics
NPI:1366098287
Name:JOINT NAPA VALLEY PHYSICAL THERAPY, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JOINT NAPA VALLEY PHYSICAL THERAPY, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WIESNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:707-287-4437
Mailing Address - Street 1:1282 VIDOVICH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-2052
Mailing Address - Country:US
Mailing Address - Phone:707-287-4437
Mailing Address - Fax:
Practice Address - Street 1:1282 VIDOVICH AVE STE D
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-2052
Practice Address - Country:US
Practice Address - Phone:707-287-4437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134453467OtherNPI