Healthcare Provider Details

I. General information

NPI: 1740525948
Provider Name (Legal Business Name): MICHAEL THOMAS CHIN P.T., D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1673 S MAIN ST
MILPITAS CA
95035-6200
US

IV. Provider business mailing address

1673 S MAIN ST
MILPITAS CA
95035-6200
US

V. Phone/Fax

Practice location:
  • Phone: 408-495-3743
  • Fax:
Mailing address:
  • Phone: 408-495-3743
  • Fax: 650-345-2756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number39676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: