Provider Demographics
NPI:1396020624
Name:WADHAWAN, ASHWINDER KAUR (PT)
Entity Type:Individual
Prefix:
First Name:ASHWINDER
Middle Name:KAUR
Last Name:WADHAWAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1648 NORD LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5030
Mailing Address - Country:US
Mailing Address - Phone:408-569-1438
Mailing Address - Fax:
Practice Address - Street 1:39141 CIVIC CENTER DR
Practice Address - Street 2:SUITE 120
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-5818
Practice Address - Country:US
Practice Address - Phone:510-794-9672
Practice Address - Fax:510-792-8138
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT38336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA105763Medicare PIN