Provider Demographics
NPI:1760741722
Name:SILVER CREEK PHYSICAL THERAPY SUNNYVALE
Entity Type:Organization
Organization Name:SILVER CREEK PHYSICAL THERAPY SUNNYVALE
Other - Org Name:SILVER CREEK PHYSICAL THERAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:WALTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:408-841-7203
Mailing Address - Street 1:4205 SAN FELIPE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1503
Mailing Address - Country:US
Mailing Address - Phone:408-238-1552
Mailing Address - Fax:
Practice Address - Street 1:500 E REMINGTON DR
Practice Address - Street 2:STE 10
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2657
Practice Address - Country:US
Practice Address - Phone:408-289-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGI340AMedicare UPIN