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General NPI Number Information
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NPI Number | 1922140003
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Entity Type | Organization
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Legal Business Name | INDIVIDUALIZED PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/05/2016
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Provider Practice Location Address
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Address Line | 17705 HALE AVE STE H6
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City | MORGAN HILL
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State | CA
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Zip | 95037-4340
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Country | US
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Telephone | 408-778-6800
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Fax | 408-762-4488
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Provider Business Mailing Address
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Address Line | 17705 HALE AVE STE H6
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City | MORGAN HILL
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State | CA
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Zip | 95037-4340
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Country | US
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Telephone | 408-778-6800
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Fax | 408-762-4488
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | TRACY LEA HALMOS
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Credential | MPT, ATC, CSCS
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Telephone | 408-778-6800
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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 |
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License Number State |
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