Provider Demographics
NPI:1073838744
Name:JAGADEESH, MADHURI
Entity Type:Individual
Prefix:
First Name:MADHURI
Middle Name:
Last Name:JAGADEESH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LAS COLINAS LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1212
Mailing Address - Country:US
Mailing Address - Phone:408-284-2812
Mailing Address - Fax:408-284-2875
Practice Address - Street 1:30 LAS COLINAS LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1212
Practice Address - Country:US
Practice Address - Phone:408-284-2812
Practice Address - Fax:408-284-2875
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist