Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 30346 | CA |
NPI | 1003029612 |
---|---|
Provider Name | Annapoorna Pidikiti |
First Address | Fremont, CA 94539-8102 |
Second Address | Fairfield, CA 94533-6066 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 18/11/2019 |