Healthcare Provider Details

I. General information

NPI: 1578475547
Provider Name (Legal Business Name): PETER STARKWEATHER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 JACKSON ST STE 10
LOS GATOS CA
95030-7141
US

IV. Provider business mailing address

5019 LAPA DR APT 2
SAN JOSE CA
95129-1828
US

V. Phone/Fax

Practice location:
  • Phone: 209-233-5153
  • Fax:
Mailing address:
  • Phone: 209-233-5153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number73853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: