MEDICARE: MINDMOTION PHYSICAL THERAPY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1336900539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDMOTION PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	6342 CAMDEN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-5322
Country	:	US
Telephone Number	:	408-569-7299
Fax Number	:

Provider Business Practice Location Address
First Line	:	6342 CAMDEN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-5322
Country	:	US
Telephone Number	:	408-569-7299
Fax Number	:

Authorized Official
Title or Position	:	CEO, OWNER
Name	:	BOGDAN KATKOV
Credential	:	PT, DPT
Telephone Number	:	408-569-7299

Provider Enumeration Date	:	01/16/2024
Last Update Date	:	01/16/2024

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