# ATIVA PHYSICAL MEDICINE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760130827
- **Authorized official:** DR. TAM LY DC (CLINIC DIRECTOR)
- **Authorized official phone:** (408) 256-3865

## Contact information

- **Practice address:** 4950 HAMILTON AVE STE 109, SAN JOSE, CA 95130-1748
- **Practice address phone:** (408) 256-3865
- **Practice address fax:** (408) 883-8171
- **Mailing address:** 4950 HAMILTON AVE STE 109, SAN JOSE, CA 95130-1748
- **Mailing address phone:** (408) 256-3865
- **Mailing address fax:** (408) 883-8171

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/16/2022
- **Last updated:** 03/16/2022