Healthcare Provider Details

I. General information

NPI: 1407107238
Provider Name (Legal Business Name): THANIT NOOM SIRIMATUROS PT, DPT, FAAOMPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 EL CAMINO REAL
PALO ALTO CA
94306-3324
US

IV. Provider business mailing address

4038 FITZPATRICK WAY
SANTA CLARA CA
95054-4194
US

V. Phone/Fax

Practice location:
  • Phone: 650-565-8090
  • Fax:
Mailing address:
  • Phone: 626-922-7139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39389
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number39389
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number39389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: