Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 030940-1 | NY |
Y | 225100000X | Physical Therapist | PT 37305 | CA |
NPI | 1003142837 |
---|---|
Provider Name | Ramya Gandrakota |
First Address | Sunnyvale, CA 94086-4807 |
Second Address | Sunnyvale, CA 94086-4807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2009 |
Last Update Date | 12/05/2011 |