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General NPI Number Information
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NPI Number | 1609273564
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Entity Type | Organization
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Legal Business Name | SILVER CREEK PHYSICAL THERAPY LOS GATOS PC
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 04/09/2020
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Provider Practice Location Address
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Address Line | 14103 WINCHESTER BLVD STE F
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City | LOS GATOS
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State | CA
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Zip | 95032-1835
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Country | US
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Telephone | 408-868-5577
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Fax | 408-868-5577
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Provider Business Mailing Address
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Address Line | 4205 SAN FELIPE RD 100
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City | SAN JOSE
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State | CA
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Zip | 95135-1503
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Country | US
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Telephone | 408-841-7203
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JOHN RANDALL WALTZ
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Credential | MPT
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Telephone | 408-841-7203
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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 |
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License Number State |
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