Provider Demographics
NPI:1922672096
Name:SUBHASH, ANITHA
Entity Type:Individual
Prefix:
First Name:ANITHA
Middle Name:
Last Name:SUBHASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANITHA
Other - Middle Name:
Other - Last Name:SUBHASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:CALIFORNIA LUNA CARE PHYSICAL THERAPY
Mailing Address - Street 2:16185 SUIT 205
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3545
Mailing Address - Country:US
Mailing Address - Phone:916-666-6678
Mailing Address - Fax:
Practice Address - Street 1:12478 SALMON RIVER RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-3545
Practice Address - Country:US
Practice Address - Phone:858-776-1808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32931208100000X
CA32931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty