Provider Demographics
NPI:1669455879
Name:HAWORTH, PHILIP J (PT)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:HAWORTH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 612260
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95161-2260
Mailing Address - Country:US
Mailing Address - Phone:877-325-2776
Mailing Address - Fax:408-945-4011
Practice Address - Street 1:3395 S BASCOM AVE
Practice Address - Street 2:#140
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-6770
Practice Address - Country:US
Practice Address - Phone:408-369-8556
Practice Address - Fax:408-369-8560
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT302610Medicare ID - Type Unspecified