Provider Demographics
NPI:1003029612
Name:PIDIKITI, ANNAPOORNA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:ANNAPOORNA
Middle Name:
Last Name:PIDIKITI
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 SHANIKO CMN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-8102
Mailing Address - Country:US
Mailing Address - Phone:408-250-2843
Mailing Address - Fax:408-250-2843
Practice Address - Street 1:1652 W TEXAS ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6066
Practice Address - Country:US
Practice Address - Phone:408-250-2843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist