Provider Demographics
NPI:1942218375
Name:SASAO, MARK ALAN (MPT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALAN
Last Name:SASAO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3756 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-2662
Mailing Address - Country:US
Mailing Address - Phone:408-559-5119
Mailing Address - Fax:408-559-5139
Practice Address - Street 1:3756 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2662
Practice Address - Country:US
Practice Address - Phone:408-559-5119
Practice Address - Fax:408-559-5139
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1550702251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ52041YOtherBLUE SHIELD PIN
CA0PT155070Medicare PIN