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General NPI Number Information
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NPI Number | 1619066677
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Entity Type | Organization
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Legal Business Name | ERGO REHABILITATION INC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 39201 STATE ST
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City | FREMONT
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State | CA
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Zip | 94538-1437
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Country | US
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Telephone | 510-791-5521
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Fax |
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Provider Business Mailing Address
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Address Line | 859 CELEBRATION DR
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City | MILPITAS
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State | CA
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Zip | 95035-8766
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Country | US
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Telephone | 408-263-5022
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN KAVAS
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Credential | P.T.
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Telephone | 510-791-5521
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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 | 23448
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License Number State | CA
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