Provider Demographics
NPI:1326579012
Name:SALU PHYSICAL THERAPY P C
Entity Type:Organization
Organization Name:SALU PHYSICAL THERAPY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:SHAO
Authorized Official - Last Name:HUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:408-921-1463
Mailing Address - Street 1:2064 WALSH AVE
Mailing Address - Street 2:B2
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-2526
Mailing Address - Country:US
Mailing Address - Phone:408-320-2725
Mailing Address - Fax:
Practice Address - Street 1:2064 WALSH AVE
Practice Address - Street 2:B2
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-2526
Practice Address - Country:US
Practice Address - Phone:408-921-1463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty