Individual
MR. GINO DIZON LEGASPI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
751 S BASCOM AVE, SAN JOSE, CA 95128-2604
(408) 885-4342
Mailing address
2087 WENDOVER LN, SAN JOSE, CA 95121-1465
(510) 378-6503
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
10822
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10822
PHYSICAL THERAPY BOARD OF CALIFORNIA
CA
Enumeration date
06/11/2020
Last updated
06/11/2020
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