Healthcare Provider Details

I. General information

NPI: 1659445443
Provider Name (Legal Business Name): AGILE PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 EL CAMINO REAL SUITE 101
PALO ALTO CA
94306-1706
US

IV. Provider business mailing address

2450 EL CAMINO REAL SUITE 101
PALO ALTO CA
94306-1706
US

V. Phone/Fax

Practice location:
  • Phone: 650-565-8090
  • Fax: 650-565-8095
Mailing address:
  • Phone: 650-565-8090
  • Fax: 650-565-8095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT17712
License Number StateCA

VIII. Authorized Official

Name: MISS CHRISTINA COLE
Title or Position: BOOKKEEPER
Credential:
Phone: 650-565-8090