Provider Demographics
NPI:1972951903
Name:SPECIALIZED PHYSICAL THERAPY SOLUTIONS, INC.
Entity Type:Organization
Organization Name:SPECIALIZED PHYSICAL THERAPY SOLUTIONS, INC.
Other - Org Name:SPECIALIZED PT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUC
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:408-396-5601
Mailing Address - Street 1:2200 LAFAYETTE ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-2915
Mailing Address - Country:US
Mailing Address - Phone:408-753-9988
Mailing Address - Fax:408-899-2656
Practice Address - Street 1:2200 LAFAYETTE ST STE 4
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-2915
Practice Address - Country:US
Practice Address - Phone:408-753-9988
Practice Address - Fax:408-899-2656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT333790Medicare PIN