Provider Demographics
NPI:1710507173
Name:GUMMADI, ASHA J (PT)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:J
Last Name:GUMMADI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ASHA
Other - Middle Name:JYOTHI
Other - Last Name:GUMMADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1932 WALNUT PLZ
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-5810
Mailing Address - Country:US
Mailing Address - Phone:469-892-5222
Mailing Address - Fax:469-892-5222
Practice Address - Street 1:9595 NEEDLES AVE
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-1514
Practice Address - Country:US
Practice Address - Phone:312-420-1654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-25
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12279402251N0400X
PAPT020872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist