Healthcare Provider Details

I. General information

NPI: 1700252962
Provider Name (Legal Business Name): SCOLIOSIS REHAB, INC.-CA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3162 NEWBERRY DR SUITE 20
SAN JOSE CA
95118-1500
US

IV. Provider business mailing address

3162 NEWBERRY DR SUITE 20
SAN JOSE CA
95118-1500
US

V. Phone/Fax

Practice location:
  • Phone: 408-785-1774
  • Fax: 408-470-7733
Mailing address:
  • Phone: 408-785-1774
  • Fax: 408-470-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19454
License Number StateCA

VIII. Authorized Official

Name: NANCY A SHERRATT
Title or Position: OWNER
Credential: PT
Phone: 408-785-1774