=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194464446
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WORKFORCE PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2022
-----------------------------------------------------
Last Update Date | 06/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 484 OAK RD RM 206
-----------------------------------------------------
City | STANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94305-4502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-684-8974
-----------------------------------------------------
Fax | 408-608-1993
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 142 N MILPITAS BLVD # 398
-----------------------------------------------------
City | MILPITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95035-4401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-931-2493
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ABDULHAMID BANAFA
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 408-931-2493
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------