Provider Demographics
NPI:1154558559
Name:SUN PHYSICAL THERAPY
Entity type:Organization
Organization Name:SUN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:URVASHI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, PT
Authorized Official - Phone:510-742-9580
Mailing Address - Street 1:3800 WALNUT AVE APT 303B
Mailing Address - Street 2:SUN PHYSICAL THERAPY
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2290
Mailing Address - Country:US
Mailing Address - Phone:510-742-9580
Mailing Address - Fax:
Practice Address - Street 1:3800 WALNUT AVE APT 303B
Practice Address - Street 2:SUN PHYSICAL THERAPY
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2290
Practice Address - Country:US
Practice Address - Phone:510-742-9580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty