Provider Demographics
NPI:1134150469
Name:MANIAR-OZA, SUPRIYA AMEESH (PT)
Entity type:Individual
Prefix:
First Name:SUPRIYA
Middle Name:AMEESH
Last Name:MANIAR-OZA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6489 CAMDEN AVE
Mailing Address - Street 2:STE 109
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-2849
Mailing Address - Country:US
Mailing Address - Phone:408-268-0600
Mailing Address - Fax:408-268-0602
Practice Address - Street 1:6489 CAMDEN AVE
Practice Address - Street 2:STE 109
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2849
Practice Address - Country:US
Practice Address - Phone:408-268-0600
Practice Address - Fax:408-268-0602
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 15763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT157630Medicare PIN