MEDICARE: MR. MARK ALAN SASAO M.P.T.

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	2251X0800X	Orthopedic Physical Therapist	155070	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ52041Y	OTHER	CA	BLUE SHIELD PIN

General Provider Information

NPI Number	:	1942218375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK ALAN SASAO M.P.T.

Provider Business Mailing Address
First Line	:	3756 S BASCOM AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-2662
Country	:	US
Telephone Number	:	408-559-5119
Fax Number	:	408-559-5139

Provider Business Practice Location Address
First Line	:	3756 S BASCOM AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-2662
Country	:	US
Telephone Number	:	408-559-5119
Fax Number	:	408-559-5139

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/30/2009

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