Provider Demographics
NPI:1184645863
Name:CUPERTINO PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:CUPERTINO PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MURDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:408-873-8188
Mailing Address - Street 1:1054 S. DE ANZA BLVD, SUITE 120
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3553
Mailing Address - Country:US
Mailing Address - Phone:408-873-8100
Mailing Address - Fax:408-873-8138
Practice Address - Street 1:1054 S. DE ANZA BLVD, SUITE 120
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3553
Practice Address - Country:US
Practice Address - Phone:408-873-8100
Practice Address - Fax:408-873-8138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ65626ZOtherBLUE SHIELD
DE3340OtherRAILROAD MEDICARE
DE3340OtherRAILROAD MEDICARE