Provider Demographics
NPI:1114063153
Name:PHYSICAL THERAPY OF LOS GATOS
Entity Type:Organization
Organization Name:PHYSICAL THERAPY OF LOS GATOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:IRWIN
Authorized Official - Last Name:NABER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:408-358-6505
Mailing Address - Street 1:15047 LOS GATOS BOULEVARD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2054
Mailing Address - Country:US
Mailing Address - Phone:408-358-6505
Mailing Address - Fax:408-358-6404
Practice Address - Street 1:15047 LOS GATOS BOULEVARD
Practice Address - Street 2:SUITE 180
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2054
Practice Address - Country:US
Practice Address - Phone:408-358-6505
Practice Address - Fax:408-358-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT122572251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty