Provider Demographics
NPI:1811013238
Name:TRIVEDI, NEETU S (THERAPY DIR)
Entity Type:Individual
Prefix:
First Name:NEETU
Middle Name:S
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:THERAPY DIR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 VINTAGE CIR UNIT 3158
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6257
Mailing Address - Country:US
Mailing Address - Phone:404-275-7850
Mailing Address - Fax:
Practice Address - Street 1:5980 STONERIDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2723
Practice Address - Country:US
Practice Address - Phone:925-847-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0077532083P0500X
CA293715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine