Provider Demographics
NPI:1992829253
Name:TRUDI HENEWEER TRYGG AND KAREN GROSS FUJIMOTO PHYSICAL THERAPISTS, INC
Entity Type:Organization
Organization Name:TRUDI HENEWEER TRYGG AND KAREN GROSS FUJIMOTO PHYSICAL THERAPISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:TRYGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-493-3778
Mailing Address - Street 1:401 LAMBERT AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2220
Mailing Address - Country:US
Mailing Address - Phone:650-493-3778
Mailing Address - Fax:
Practice Address - Street 1:401 LAMBERT AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-2220
Practice Address - Country:US
Practice Address - Phone:650-493-3778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ39654ZOtherBLUE SHIELD
CAZZZ39654ZOtherBLUE SHIELD
CAZZZ07754ZMedicare UPIN