MEDICARE: RICK SHON PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	303249	CA

General Provider Information

NPI Number	:	1003525544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICK SHON PT, DPT

Provider Business Mailing Address
First Line	:	6065 MERIDIAN AVE STE 70
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2772
Country	:	US
Telephone Number	:	408-927-0871
Fax Number	:

Provider Business Practice Location Address
First Line	:	6065 MERIDIAN AVE STE 70
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2772
Country	:	US
Telephone Number	:	408-927-0871
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2022
Last Update Date	:	11/22/2022

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