Provider Demographics
NPI:1093583262
Name:RAO, TEJASHREE SRIDHAR (DPT)
Entity Type:Individual
Prefix:DR
First Name:TEJASHREE
Middle Name:SRIDHAR
Last Name:RAO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 SUMMIT AVE # 3
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2702
Mailing Address - Country:US
Mailing Address - Phone:909-319-9495
Mailing Address - Fax:
Practice Address - Street 1:3063 38TH ST STE C1
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4172
Practice Address - Country:US
Practice Address - Phone:718-932-1269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051560-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist