Healthcare Provider Details

I. General information

NPI: 1063510337
Provider Name (Legal Business Name): SILVER CREEK FITNESS AND PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 SAN FELIPE RD SUITE 100
SAN JOSE CA
95135-1503
US

IV. Provider business mailing address

PO BOX 858
FRANKLIN TN
37065-0858
US

V. Phone/Fax

Practice location:
  • Phone: 408-841-7203
  • Fax:
Mailing address:
  • Phone: 408-238-1552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. BOBBY ISMAIL
Title or Position: PRESIDENT
Credential: DPT
Phone: 209-353-1988