Healthcare Provider Details

I. General information

NPI: 1598922965
Provider Name (Legal Business Name): CHRISTY LEE SILVA JUCO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 12/20/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 GREAK OAKS
SAN JOSE CA
95119-2900
US

IV. Provider business mailing address

6180 FRANCISCAN WAY
SAN JOSE CA
95120-4454
US

V. Phone/Fax

Practice location:
  • Phone: 408-361-2100
  • Fax:
Mailing address:
  • Phone: 408-410-1208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number026079
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16134
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number27991
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: