Provider Demographics
NPI:1649674201
Name:MAGO, AKANKSHA (PT)
Entity type:Individual
Prefix:
First Name:AKANKSHA
Middle Name:
Last Name:MAGO
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
Mailing Address - Street 2:SUITE# 102
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
Practice Address - Street 2:SUITE# 102
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:2014-10-10
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT41619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist