Healthcare Provider Details

I. General information

NPI: 1467792580
Provider Name (Legal Business Name): WINNIE MA P.T., DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 EL CAMINO REAL
PALO ALTO CA
94301
US

IV. Provider business mailing address

2350 W. EL CAMINO REAL 2ND FLOOR
MOUNTAIN VIEW CA
94040-6203
US

V. Phone/Fax

Practice location:
  • Phone: 650-853-3355
  • Fax: 650-853-3313
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: