Provider Demographics
NPI:1003525544
Name:SHON, RICK (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:SHON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6065 MERIDIAN AVE STE 70
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-2772
Mailing Address - Country:US
Mailing Address - Phone:408-927-0871
Mailing Address - Fax:
Practice Address - Street 1:6065 MERIDIAN AVE STE 70
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2772
Practice Address - Country:US
Practice Address - Phone:408-927-0871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303249261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy