Provider Demographics
NPI:1346876687
Name:JEANETTE KROGSTAD PHYSICAL THERAPY
Entity Type:Organization
Organization Name:JEANETTE KROGSTAD PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KROGSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:408-718-7788
Mailing Address - Street 1:1046 PILINUT CT
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1841
Mailing Address - Country:US
Mailing Address - Phone:408-718-7788
Mailing Address - Fax:
Practice Address - Street 1:350 STATE ST
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-2815
Practice Address - Country:US
Practice Address - Phone:408-718-7788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy