Provider Demographics
NPI:1730238361
Name:MOHAMMED, SHARDA (BSC PT)
Entity type:Individual
Prefix:MRS
First Name:SHARDA
Middle Name:
Last Name:MOHAMMED
Suffix:
Gender:F
Credentials:BSC PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 ELAN VILLAGE LANE
Mailing Address - Street 2:APT #312
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134
Mailing Address - Country:US
Mailing Address - Phone:408-383-9013
Mailing Address - Fax:
Practice Address - Street 1:900 KEILY BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051
Practice Address - Country:US
Practice Address - Phone:408-236-5041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist