Provider Demographics
NPI:1699043992
Name:ASSALY, SHIREN GABI (PT)
Entity Type:Individual
Prefix:
First Name:SHIREN
Middle Name:GABI
Last Name:ASSALY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 MERIDIAN AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5350
Mailing Address - Country:US
Mailing Address - Phone:408-979-2300
Mailing Address - Fax:408-979-2301
Practice Address - Street 1:1530 MERIDIAN AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5350
Practice Address - Country:US
Practice Address - Phone:408-979-2300
Practice Address - Fax:408-979-2301
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 38489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFX233ZMedicare PIN