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Organization
PT2 PHYSICAL & SPORTS THERAPY INC.
Active
Organization
PT2 PHYSICAL & SPORTS THERAPY INC.
Active
Other names
PT2 Physical & Sports Therapy with a Personal Touch
Organization subpart
No
Provider details
NPI number
Authorized official
MARK DEBASITIS (VICE PRESIDENT)
(408) 225-8778
Entity
Organization
Contact information
Practice address
6920 SANTA TERESA BLVD, SUITE 109, SAN JOSE, CA 95119-1344
(408) 225-8778
(408) 225-8760
Mailing address
6920 SANTA TERESA BLVD, SUITE 109, SAN JOSE, CA 95119-1344
(408) 225-8778
(408) 225-8760
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT18877
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ08001Z
BLUE SHIELD PPO GROUP #
CA
Enumeration date
07/08/2006
Last updated
08/22/2020
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