Provider Demographics
NPI:1497762751
Name:DAVID, REYNA-ATHENA SAMALEA (DPT)
Entity Type:Individual
Prefix:
First Name:REYNA-ATHENA
Middle Name:SAMALEA
Last Name:DAVID
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18780 COX AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4109
Mailing Address - Country:US
Mailing Address - Phone:408-973-7700
Mailing Address - Fax:408-973-1600
Practice Address - Street 1:12900 SARATOGA AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-4666
Practice Address - Country:US
Practice Address - Phone:408-354-2223
Practice Address - Fax:408-354-2228
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT329191Medicare PIN