Provider Demographics
NPI:1629221783
Name:ACHARYA, GAYATRI RAMANUJAM (BPT)
Entity Type:Individual
Prefix:
First Name:GAYATRI
Middle Name:RAMANUJAM
Last Name:ACHARYA
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 1:785 LAS PALMAS DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2319
Mailing Address - Country:US
Mailing Address - Phone:732-754-7153
Mailing Address - Fax:
Practice Address - Street 1:785 LAS PALMAS DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-2319
Practice Address - Country:US
Practice Address - Phone:732-754-7153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-02
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029867225100000X
CA36109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist