Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT13225 | CA |
NPI | 1275613119 |
---|---|
Provider Name | Mr. Chris M. Ota |
First Address | Campbell, CA 95008-0234 |
Second Address | Campbell, CA 95008-0234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 18/10/2021 |