Organization
ATIVA PHYSICAL MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAM LY DC (CLINIC DIRECTOR)
(408) 256-3865
Entity
Organization
Contact information
Practice address
4950 HAMILTON AVE STE 109, SAN JOSE, CA 95130-1748
(408) 256-3865
(408) 883-8171
Mailing address
4950 HAMILTON AVE STE 109, SAN JOSE, CA 95130-1748
(408) 256-3865
(408) 883-8171
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
03/16/2022
Last updated
03/16/2022
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