Provider Demographics
NPI:1043788854
Name:GAJJAR, SUCHIBEN (PT,DPT)
Entity Type:Individual
Prefix:
First Name:SUCHIBEN
Middle Name:
Last Name:GAJJAR
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:DR
Other - First Name:SUCHI
Other - Middle Name:
Other - Last Name:GAJJAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:4124 RAINY CREEK LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3174
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4124 RAINY CREEK LN
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3174
Practice Address - Country:US
Practice Address - Phone:201-467-9297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1244460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist