Provider Demographics
NPI:1467916742
Name:ROOT, RIA ANNE SUGIJANTO (DPT)
Entity type:Individual
Prefix:
First Name:RIA
Middle Name:ANNE SUGIJANTO
Last Name:ROOT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:RIA
Other - Middle Name:ANNE
Other - Last Name:SUGIJANTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6907 SHIRAZ WAY
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-4465
Mailing Address - Country:US
Mailing Address - Phone:925-360-8560
Mailing Address - Fax:
Practice Address - Street 1:350 JOHN MUIR PKWY STE 250
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5194
Practice Address - Country:US
Practice Address - Phone:925-308-8160
Practice Address - Fax:925-308-8760
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT295813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist