Provider Demographics
NPI:1508363458
Name:ZALAVADIYA, MAMTA
Entity Type:Individual
Prefix:
First Name:MAMTA
Middle Name:
Last Name:ZALAVADIYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 MISSION SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-3031
Mailing Address - Country:US
Mailing Address - Phone:551-580-6242
Mailing Address - Fax:
Practice Address - Street 1:1575 MISSION SPRINGS CIR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-3031
Practice Address - Country:US
Practice Address - Phone:551-580-6242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-08
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist