Provider Demographics
NPI:1063510337
Name:SILVER CREEK FITNESS AND PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SILVER CREEK FITNESS AND PHYSICAL THERAPY
Other - Org Name:SILVER CREEK PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:209-353-1988
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37065-0858
Mailing Address - Country:US
Mailing Address - Phone:408-238-1552
Mailing Address - Fax:
Practice Address - Street 1:4205 SAN FELIPE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95135-1503
Practice Address - Country:US
Practice Address - Phone:408-841-7203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01604ZMedicare UPIN
CAZZZ01487ZMedicare UPIN
CAZZZ24076ZMedicare UPIN