Provider Demographics
NPI:1861030488
Name:MATSUSHITA, ERI
Entity Type:Individual
Prefix:
First Name:ERI
Middle Name:
Last Name:MATSUSHITA
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 1:333 SOQUEL AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-4102
Mailing Address - Country:US
Mailing Address - Phone:408-736-7600
Mailing Address - Fax:408-736-7604
Practice Address - Street 1:333 SOQUEL WAY
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4102
Practice Address - Country:US
Practice Address - Phone:408-736-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT297525225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053320325OtherGROUP NPI
ZZZ29361ZOtherGROUP MEDICARE NUMBER