Provider Demographics
NPI:1093571069
Name:FALK, ENRIQUE JOHAN (DPT)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:JOHAN
Last Name:FALK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SOQUEL WAY
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-4102
Mailing Address - Country:US
Mailing Address - Phone:408-736-7600
Mailing Address - Fax:
Practice Address - Street 1:333 SOQUEL WAY
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4102
Practice Address - Country:US
Practice Address - Phone:408-736-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT305553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ29361ZOtherMCPTAN
1053320325OtherGROUP NPI