Provider Demographics
NPI:1427593003
Name:MODI, NIDHI ADITYA
Entity Type:Individual
Prefix:
First Name:NIDHI
Middle Name:ADITYA
Last Name:MODI
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 1:1000 FREMONT AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-6054
Mailing Address - Country:US
Mailing Address - Phone:650-947-8500
Mailing Address - Fax:650-947-8501
Practice Address - Street 1:1000 FREMONT AVE STE 108
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-6054
Practice Address - Country:US
Practice Address - Phone:650-947-8500
Practice Address - Fax:650-947-8501
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist