Healthcare Provider Details

I. General information

NPI: 1942218375
Provider Name (Legal Business Name): MARK ALAN SASAO M.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3756 S BASCOM AVE
SAN JOSE CA
95124-2662
US

IV. Provider business mailing address

3756 S BASCOM AVE
SAN JOSE CA
95124-2662
US

V. Phone/Fax

Practice location:
  • Phone: 408-559-5119
  • Fax: 408-559-5139
Mailing address:
  • Phone: 408-559-5119
  • Fax: 408-559-5139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number155070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: