Provider Demographics
NPI:1306279344
Name:SIFUENTES, LAURA JANE (DPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JANE
Last Name:SIFUENTES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10390 COLOMA RD STE 7
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2152
Mailing Address - Country:US
Mailing Address - Phone:916-858-0950
Mailing Address - Fax:916-858-0972
Practice Address - Street 1:1535 RIVER PARK DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4601
Practice Address - Country:US
Practice Address - Phone:916-286-1000
Practice Address - Fax:916-858-0972
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT402992251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic