Provider Demographics
NPI:1891739314
Name:INTRAHEALTH PHYSICAL THERAPY
Entity Type:Organization
Organization Name:INTRAHEALTH PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:EGGERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-530-0005
Mailing Address - Street 1:21020 HOMESTEAD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-0240
Mailing Address - Country:US
Mailing Address - Phone:408-530-0005
Mailing Address - Fax:408-530-9473
Practice Address - Street 1:21020 HOMESTEAD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-0240
Practice Address - Country:US
Practice Address - Phone:408-530-0005
Practice Address - Fax:408-530-9473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64183ZOtherBLUE SHIELD PIN
CAZZZ64183ZOtherBLUE SHIELD PIN