Healthcare Provider Details

I. General information

NPI: 1609273564
Provider Name (Legal Business Name): SILVER CREEK PHYSICAL THERAPY LOS GATOS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14103 WINCHESTER BLVD STE F
LOS GATOS CA
95032-1835
US

IV. Provider business mailing address

4205 SAN FELIPE RD 100
SAN JOSE CA
95135-1503
US

V. Phone/Fax

Practice location:
  • Phone: 408-868-5577
  • Fax: 408-868-5577
Mailing address:
  • Phone: 408-841-7203
  • 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: MR. JOHN RANDALL WALTZ
Title or Position: CEO
Credential: MPT
Phone: 408-841-7203