Provider Demographics
NPI:1437873718
Name:TAWADE, SAMIKSHA RAJESH
Entity Type:Individual
Prefix:
First Name:SAMIKSHA
Middle Name:RAJESH
Last Name:TAWADE
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 1:41 E 8TH ST APT 3205
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2441
Mailing Address - Country:US
Mailing Address - Phone:312-826-2905
Mailing Address - Fax:
Practice Address - Street 1:425 KINGSTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3127
Practice Address - Country:US
Practice Address - Phone:718-659-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048806225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist