Backtogolf Performance & Fitness Inc
NPI 1669571188ActiveOrganization· Physical Therapist· Santa Rosa, CA
Physical Therapist in Santa Rosa, California, registered in NPPES in September 2006. The authorized official on file is Mary K. Mullnix, Practice Administrator. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1669571188 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Sep 21, 2006 |
| Last updated in NPPES | Apr 14, 2020 |
| Certified by provider | Apr 14, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | PT11380 | CA |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (CA) |
|---|
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