Healthcare Provider Details

I. General information

NPI: 1760741722
Provider Name (Legal Business Name): SILVER CREEK PHYSICAL THERAPY SUNNYVALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E REMINGTON DR STE 10
SUNNYVALE CA
94087-2657
US

IV. Provider business mailing address

4205 SAN FELIPE RD STE 100
SAN JOSE CA
95135-1503
US

V. Phone/Fax

Practice location:
  • Phone: 408-289-3600
  • Fax:
Mailing address:
  • Phone: 408-238-1552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number36199
License Number StateCA

VIII. Authorized Official

Name: MR. JOHN RANDALL WALTZ
Title or Position: OWNER
Credential: MPT
Phone: 408-841-7203