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General NPI Number Information
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NPI Number | 1689752834
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Entity Type | Organization
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Legal Business Name | MILPITAS PHYSICAL THERAPY CLINIC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1103 S PARK VICTORIA DR
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City | MILPITAS
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State | CA
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Zip | 95035-6942
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Country | US
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Telephone | 408-263-2020
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Fax | 408-263-8537
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Provider Business Mailing Address
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Address Line | 1103 S PARK VICTORIA DR
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City | MILPITAS
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State | CA
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Zip | 95035-6942
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Country | US
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Telephone | 408-263-2020
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Fax | 408-263-8537
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | DAVID SEVERSON
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Credential | P.T.
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Telephone | 408-263-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 09361
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License Number State | CA
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