Provider Demographics
NPI:1578152047
Name:RANDHAWA, JASMEEN (PT)
Entity Type:Individual
Prefix:
First Name:JASMEEN
Middle Name:
Last Name:RANDHAWA
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 1:1700 E BULLARD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5866
Mailing Address - Country:US
Mailing Address - Phone:559-438-8531
Mailing Address - Fax:559-438-8307
Practice Address - Street 1:1700 E BULLARD AVE STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5866
Practice Address - Country:US
Practice Address - Phone:559-438-8531
Practice Address - Fax:559-438-8307
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT299726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT299726OtherPHYSICAL THERAPY BOARD OF CALIFORNIA