Provider Demographics
NPI:1831255454
Name:TOWNSEND, DAVID WILLIAM (MPT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:TOWNSEND
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 CHALLENGER WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-5423
Mailing Address - Country:US
Mailing Address - Phone:707-545-1419
Mailing Address - Fax:707-545-1435
Practice Address - Street 1:2255 CHALLENGER WAY STE 104
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5423
Practice Address - Country:US
Practice Address - Phone:707-545-1419
Practice Address - Fax:707-545-1435
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT246891Medicare ID - Type Unspecified