Provider Demographics
NPI:1134467236
Name:SILICON VALLEY MASSAGE THERAPY GROUP
Entity Type:Organization
Organization Name:SILICON VALLEY MASSAGE THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, CMT
Authorized Official - Phone:408-260-2256
Mailing Address - Street 1:920 SARATOGA AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3403
Mailing Address - Country:US
Mailing Address - Phone:408-260-2256
Mailing Address - Fax:
Practice Address - Street 1:920 SARATOGA AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3403
Practice Address - Country:US
Practice Address - Phone:408-260-2256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28606225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty