Provider Demographics
NPI:1104217660
Name:MODI, DRASHTI
Entity Type:Individual
Prefix:
First Name:DRASHTI
Middle Name:
Last Name:MODI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20823 STEVENS CREEK BLVD
Mailing Address - Street 2:#200
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2108
Mailing Address - Country:US
Mailing Address - Phone:408-252-6076
Mailing Address - Fax:408-252-1159
Practice Address - Street 1:20823 STEVENS CREEK BLVD
Practice Address - Street 2:#200
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2108
Practice Address - Country:US
Practice Address - Phone:408-252-6076
Practice Address - Fax:408-252-1159
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA42201OtherPHYSICAL THERAPIST LICENSE