MEDICARE: MS. CYNTHIA UYEMOTO FONG PT

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	225100000X	Physical Therapist	6736	CA

General Provider Information

NPI Number	:	1649346511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA UYEMOTO FONG PT

Provider Business Mailing Address
First Line	:	270 INTERNATIONAL CIR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1130
Country	:	US
Telephone Number	:	408-972-6400
Fax Number	:	408-972-6415

Provider Business Practice Location Address
First Line	:	270 INTERNATIONAL CIR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1100
Country	:	US
Telephone Number	:	408-972-6400
Fax Number	:	408-972-6415

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	07/08/2007

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