Provider Demographics
NPI:1659481380
Name:DRAXTON, MARIE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:DRAXTON
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 1:14895 CONWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4319
Mailing Address - Country:US
Mailing Address - Phone:408-626-8601
Mailing Address - Fax:
Practice Address - Street 1:299 S CALIFORNIA AVE
Practice Address - Street 2:STE 300
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1935
Practice Address - Country:US
Practice Address - Phone:650-331-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2482OtherLICENSE #