Healthcare Provider Details

I. General information

NPI: 1639055973
Provider Name (Legal Business Name): KATELYN MONTEVERDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14107 WINCHESTER BLVD STE O
LOS GATOS CA
95032-1836
US

IV. Provider business mailing address

14107 WINCHESTER BLVD STE O
LOS GATOS CA
95032-1836
US

V. Phone/Fax

Practice location:
  • Phone: 408-868-5577
  • Fax:
Mailing address:
  • Phone: 408-868-5577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number308565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: