Healthcare Provider Details

I. General information

NPI: 1184645863
Provider Name (Legal Business Name): CUPERTINO PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 12/28/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 S. DE ANZA BLVD, SUITE 120
SAN JOSE CA
95129-3553
US

IV. Provider business mailing address

1054 S. DE ANZA BLVD, SUITE 120
SAN JOSE CA
95129-3553
US

V. Phone/Fax

Practice location:
  • Phone: 408-873-8100
  • Fax: 408-873-8138
Mailing address:
  • Phone: 408-873-8100
  • Fax: 408-873-8138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT24482
License Number StateCA

VIII. Authorized Official

Name: PAUL A MURDOCK
Title or Position: PHYSICIAL THERAPIST
Credential: PT
Phone: 408-873-8188