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General NPI Number Information
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NPI Number | 1992836530
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Entity Type | Individual
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Provider Name | MARILYN BASHAM P.T.
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1170 MORSE AVE
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City | SUNNYVALE
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State | CA
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Zip | 94089-1605
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Country | US
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Telephone | 408-734-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 108 TERESITA WAY
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City | LOS GATOS
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State | CA
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Zip | 95032-6517
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PT0026210
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License Number State | CA
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