Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 293043 | CA |
NPI | 1063930055 |
---|---|
Provider Name | Vidya Devarapalli |
First Address | Los Gatos, CA 95032-2637 |
Second Address | Los Gatos, CA 95032-2637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2017 |
Last Update Date | 30/08/2017 |