Provider Demographics
NPI:1649767401
Name:VIGIL, SHARLEEN (PTA)
Entity Type:Individual
Prefix:
First Name:SHARLEEN
Middle Name:
Last Name:VIGIL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3471 SURF CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-1153
Mailing Address - Country:US
Mailing Address - Phone:209-892-3998
Mailing Address - Fax:
Practice Address - Street 1:2737 WALSH AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-0965
Practice Address - Country:US
Practice Address - Phone:408-228-8400
Practice Address - Fax:408-228-8401
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT205225200000X
CAAT205225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT205OtherSTATE LICENSE