Provider Demographics
NPI:1750740387
Name:AJGAONKAR, ANISHA (PT, MHS)
Entity type:Individual
Prefix:
First Name:ANISHA
Middle Name:
Last Name:AJGAONKAR
Suffix:
Gender:
Credentials:PT, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4397
Mailing Address - Country:US
Mailing Address - Phone:317-313-6186
Mailing Address - Fax:
Practice Address - Street 1:1335 MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4397
Practice Address - Country:US
Practice Address - Phone:408-269-0701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
295636225100000X
IN05011766A225100000X
CA295636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty