Provider Demographics
NPI:1760707368
Name:NAVARRO, JAN MICHAEL R (PTA)
Entity Type:Individual
Prefix:
First Name:JAN MICHAEL
Middle Name:R
Last Name:NAVARRO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5341 EGGERS DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-7143
Mailing Address - Country:US
Mailing Address - Phone:510-396-9495
Mailing Address - Fax:
Practice Address - Street 1:5341 EGGERS DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-7143
Practice Address - Country:US
Practice Address - Phone:510-396-9495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT8113225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant