Provider Demographics
NPI:1568851731
Name:RADADIA, KOMAL (BPT)
Entity Type:Individual
Prefix:
First Name:KOMAL
Middle Name:
Last Name:RADADIA
Suffix:
Gender:F
Credentials:BPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MOWRY AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4110
Mailing Address - Country:US
Mailing Address - Phone:510-745-7700
Mailing Address - Fax:510-279-4300
Practice Address - Street 1:555 MOWRY AVE
Practice Address - Street 2:SUITE E
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4110
Practice Address - Country:US
Practice Address - Phone:510-745-7700
Practice Address - Fax:510-279-4300
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41785225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist