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General NPI Number Information
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NPI Number | 1598953937
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Entity Type | Individual
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Provider Name | PRIYA SURENDRA SAMEL RPT
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Gender | Female
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 1681 SANTA CRUZ AVE
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City | SANTA CLARA
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State | CA
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Zip | 95051-2922
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Country | US
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Telephone | 408-241-6475
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Fax | 408-241-2923
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Provider Business Mailing Address
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Address Line | 1681 SANTA CRUZ AVE
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City | SANTA CLARA
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State | CA
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Zip | 95051-2922
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Country | US
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Telephone | 408-241-6475
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Fax | 408-241-2923
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 23024
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License Number State | CA
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