Provider Demographics
NPI:1407308224
Name:MASLIN, JARROD W (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:JARROD
Middle Name:W
Last Name:MASLIN
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 CALIFORNIA ST
Mailing Address - Street 2:APT 221
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-1552
Mailing Address - Country:US
Mailing Address - Phone:530-417-7505
Mailing Address - Fax:650-851-9251
Practice Address - Street 1:150 PORTOLA RD
Practice Address - Street 2:SUITE B
Practice Address - City:PORTOLA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94028-7852
Practice Address - Country:US
Practice Address - Phone:650-851-1145
Practice Address - Fax:650-851-9251
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA291827Medicare UPIN