Provider Demographics
NPI:1578035747
Name:MALSHE, KETAKI PRAMATHESH
Entity Type:Individual
Prefix:
First Name:KETAKI
Middle Name:PRAMATHESH
Last Name:MALSHE
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 1:301 LENNON LN STE 202
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2433
Mailing Address - Country:US
Mailing Address - Phone:925-934-6373
Mailing Address - Fax:925-934-3363
Practice Address - Street 1:301 LENNON LN STE 202
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2433
Practice Address - Country:US
Practice Address - Phone:925-934-6373
Practice Address - Fax:925-934-3363
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA296052Medicaid