Provider Demographics
NPI:1346939436
Name:MEREGILLANO, GENEVA KAYLIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GENEVA
Middle Name:KAYLIN
Last Name:MEREGILLANO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 INVERNESS DR
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-7519
Mailing Address - Country:US
Mailing Address - Phone:408-685-1714
Mailing Address - Fax:
Practice Address - Street 1:305 SOUTH DR STE 5
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4207
Practice Address - Country:US
Practice Address - Phone:650-282-5554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist