Healthcare Provider Details

I. General information

NPI: 1801879267
Provider Name (Legal Business Name): NADIA MARIE TEMPLE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 FOREST AVE #104
SAN JOSE CA
95128-4817
US

IV. Provider business mailing address

246 SOBRANTE WAY #104
SUNNYVALE CA
94086-4807
US

V. Phone/Fax

Practice location:
  • Phone: 408-279-8501
  • Fax: 408-279-8504
Mailing address:
  • Phone: 408-733-3670
  • Fax: 408-245-7968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: