Provider Demographics
NPI:1366510414
Name:LOS GATOS ORTHOPEDIC SPORTS THERAPY, INC.
Entity type:Organization
Organization Name:LOS GATOS ORTHOPEDIC SPORTS THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO, PT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:M
Authorized Official - Last Name:NAKAJI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS, SCS, ATC
Authorized Official - Phone:408-358-1460
Mailing Address - Street 1:15100 LOS GATOS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2028
Mailing Address - Country:US
Mailing Address - Phone:408-358-1460
Mailing Address - Fax:
Practice Address - Street 1:15100 LOS GATOS BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2028
Practice Address - Country:US
Practice Address - Phone:408-358-1460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA226272251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty