Provider Demographics
NPI:1740981562
Name:AGRAWAL, NIDHI
Entity type:Individual
Prefix:
First Name:NIDHI
Middle Name:
Last Name:AGRAWAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11718 BEDWORTH RD
Mailing Address - Street 2:
Mailing Address - City:AGUA DULCE
Mailing Address - State:CA
Mailing Address - Zip Code:91390-4677
Mailing Address - Country:US
Mailing Address - Phone:323-240-9759
Mailing Address - Fax:
Practice Address - Street 1:11718 BEDWORTH RD
Practice Address - Street 2:
Practice Address - City:AGUA DULCE
Practice Address - State:CA
Practice Address - Zip Code:91390-4677
Practice Address - Country:US
Practice Address - Phone:323-240-9759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT297993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist