Provider Demographics
NPI:1326677485
Name:GADIA, JENNY ASIM
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:ASIM
Last Name:GADIA
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 1:3756 W AVENUE 40
Mailing Address - Street 2:STE 2B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3667
Mailing Address - Country:US
Mailing Address - Phone:323-880-9938
Mailing Address - Fax:323-739-0094
Practice Address - Street 1:3756 W AVENUE 40
Practice Address - Street 2:STE 2B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3667
Practice Address - Country:US
Practice Address - Phone:323-880-9938
Practice Address - Fax:323-344-2337
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT295206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist