Provider Demographics
NPI:1518249671
Name:VORTEX PHYSICAL THERAPY AND BALANCE, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:VORTEX PHYSICAL THERAPY AND BALANCE, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DIRON
Authorized Official - Middle Name:REESE
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:408-540-6722
Mailing Address - Street 1:3150 ALMADEN EXPY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-1260
Mailing Address - Country:US
Mailing Address - Phone:408-540-7622
Mailing Address - Fax:
Practice Address - Street 1:3150 ALMADEN EXPY
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-1260
Practice Address - Country:US
Practice Address - Phone:408-540-7622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26803261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy