Provider Demographics
NPI:1093516395
Name:RANGEL, JOSE MANUEL JR (PTA)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:MANUEL
Last Name:RANGEL
Suffix:JR
Gender:
Credentials:PTA
Other - Prefix:MR
Other - First Name:JUNIOR
Other - Middle Name:
Other - Last Name:RANGEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:77 N ALMADEN AVE APT 514
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-4101
Mailing Address - Country:US
Mailing Address - Phone:805-863-3018
Mailing Address - Fax:
Practice Address - Street 1:1604 BLOSSOM HILL RD STE 8
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-6350
Practice Address - Country:US
Practice Address - Phone:408-528-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48892225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant