Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1260737 | TX |
NPI | 1093270084 |
---|---|
Provider Name | Ashita Gadagoju |
First Address | Katy, TX 77494-6862 |
Second Address | Katy, TX 77494-0686 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2019 |
Last Update Date | 05/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
35799080 | DRIVER LICENSE (01) | TX |