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General NPI Number Information
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NPI Number | 1760130827
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Entity Type | Organization
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Legal Business Name | ATIVA PHYSICAL MEDICINE PC
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Dates
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Enumeration Date | 03/16/2022
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 4950 HAMILTON AVE STE 109
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City | SAN JOSE
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State | CA
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Zip | 95130-1748
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Country | US
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Telephone | 408-256-3865
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Fax | 408-883-8171
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Provider Business Mailing Address
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Address Line | 4950 HAMILTON AVE STE 109
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City | SAN JOSE
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State | CA
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Zip | 95130-1748
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Country | US
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Telephone | 408-256-3865
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Fax | 408-883-8171
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. TAM LY
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Credential | DC
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Telephone | 408-256-3865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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