Provider Demographics
NPI:1073536264
Name:VIVIAN, ANN TERESA (PT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:TERESA
Last Name:VIVIAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CONNEMARA WAY
Mailing Address - Street 2:#132
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3282
Mailing Address - Country:US
Mailing Address - Phone:650-696-4763
Mailing Address - Fax:650-696-4954
Practice Address - Street 1:125 CONNEMARA WAY
Practice Address - Street 2:#132
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3282
Practice Address - Country:US
Practice Address - Phone:650-696-4763
Practice Address - Fax:650-696-4954
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist