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General NPI Number Information
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NPI Number | 1902943616
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Entity Type | Organization
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Legal Business Name | DIANE SHIRAISHI & CHRIS OTA PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 2337 FOREST AVE
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City | SAN JOSE
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State | CA
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Zip | 95128-4606
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Country | US
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Telephone | 408-246-5861
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Fax | 408-246-2066
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Provider Business Mailing Address
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Address Line | 2337 FOREST AVE
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City | SAN JOSE
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State | CA
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Zip | 95128-4606
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Country | US
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Telephone | 408-246-5861
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Fax | 408-246-2066
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DIANE SHIRAISHI
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Credential | R.P.T.
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Telephone | 408-246-5861
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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 | PT5363
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License Number State | CA
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