Provider Demographics
NPI:1558683276
Name:KEWALRAMANI, SUJATA (DPT)
Entity Type:Individual
Prefix:MS
First Name:SUJATA
Middle Name:
Last Name:KEWALRAMANI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9391 LAWTON DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7244
Mailing Address - Country:US
Mailing Address - Phone:714-968-3039
Mailing Address - Fax:
Practice Address - Street 1:9391 LAWTON DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-7244
Practice Address - Country:US
Practice Address - Phone:714-968-3039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT287342251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics