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General NPI Number Information
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NPI Number | 1366510414
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Entity Type | Organization
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Legal Business Name | LOS GATOS ORTHOPEDIC SPORTS THERAPY, INC.
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15100 LOS GATOS BLVD SUITE 1
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City | LOS GATOS
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State | CA
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Zip | 95032-2028
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Country | US
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Telephone | 408-358-1460
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Fax |
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Provider Business Mailing Address
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Address Line | 15100 LOS GATOS BLVD
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City | LOS GATOS
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State | CA
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Zip | 95032-2028
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Country | US
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Telephone | 408-358-1460
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CEO, PT
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Name | MR. ROSS M. NAKAJI
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Credential | PT, OCS, SCS, ATC
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Telephone | 408-358-1460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 22627
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License Number State | CA
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