Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT020872 | PA |
Y | 2251N0400X | Physical Therapist - Neurology | 1227940 | TX |
NPI | 1710507173 |
---|---|
Provider Name | Asha J Gummadi |
First Address | Carrollton, TX 75006-5810 |
Second Address | Frisco, TX 75035-1514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2020 |
Last Update Date | 22/04/2021 |