Provider Demographics
NPI:1497913271
Name:JAGANMOHAN, PREETHI (PT)
Entity Type:Individual
Prefix:
First Name:PREETHI
Middle Name:
Last Name:JAGANMOHAN
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 1:1895 MOWRY AVE
Mailing Address - Street 2:SUITE 118A
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1737
Mailing Address - Country:US
Mailing Address - Phone:510-790-0383
Mailing Address - Fax:510-790-1197
Practice Address - Street 1:1895 MOWRY AVE
Practice Address - Street 2:SUITE 118A
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1737
Practice Address - Country:US
Practice Address - Phone:510-790-0383
Practice Address - Fax:510-790-1197
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31961ZMedicare PIN