Provider Demographics
NPI:1558953893
Name:PONDERA REHABILITATION & FITNESS, PC
Entity type:Organization
Organization Name:PONDERA REHABILITATION & FITNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZIPP
Authorized Official - Suffix:
Authorized Official - Credentials:MS OT/L
Authorized Official - Phone:530-601-9729
Mailing Address - Street 1:7311 GALILEE RD STE 175
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-7209
Mailing Address - Country:US
Mailing Address - Phone:530-601-9729
Mailing Address - Fax:530-746-0657
Practice Address - Street 1:7311 GALILEE RD STE 175
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-7209
Practice Address - Country:US
Practice Address - Phone:530-601-9729
Practice Address - Fax:530-746-0657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427134972OtherNPI INDIVIDUAL/TYPE 1