=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306582960
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERFORMANCE PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2022
-----------------------------------------------------
Last Update Date | 05/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25 N 14TH ST STE 550
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95112-6206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-294-3922
-----------------------------------------------------
Fax | 408-294-4657
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 N 14TH ST STE 550
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95112-6206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-294-3922
-----------------------------------------------------
Fax | 408-294-4657
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGE
-----------------------------------------------------
Name | SUNDEEP K SOOCH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 408-294-3922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------