Provider Demographics
NPI:1013580232
Name:VENKATESH, DIKSHA (PTA)
Entity Type:Individual
Prefix:
First Name:DIKSHA
Middle Name:
Last Name:VENKATESH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10128 E ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3304
Mailing Address - Country:US
Mailing Address - Phone:408-637-9649
Mailing Address - Fax:
Practice Address - Street 1:1100 TROUSDALE DR
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3207
Practice Address - Country:US
Practice Address - Phone:650-692-3758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-24
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51062225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant