Provider Demographics
NPI:1285901389
Name:SHIRAISHI, CRAIG (DPT)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:SHIRAISHI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-4811
Mailing Address - Country:US
Mailing Address - Phone:408-246-5861
Mailing Address - Fax:408-246-2066
Practice Address - Street 1:1026 MONROE ST
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4811
Practice Address - Country:US
Practice Address - Phone:408-246-5861
Practice Address - Fax:408-246-2066
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CAPT38079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist