Healthcare Provider Details

I. General information

NPI: 1598561359
Provider Name (Legal Business Name): WITOLD CICHON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16185 LOS GATOS BLVD STE 205
LOS GATOS CA
95032-4569
US

IV. Provider business mailing address

16185 LOS GATOS BLVD STE 205
LOS GATOS CA
95032-4569
US

V. Phone/Fax

Practice location:
  • Phone: 866-839-6979
  • Fax:
Mailing address:
  • Phone: 866-839-6979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: