Provider Demographics
NPI:1801568068
Name:JANGID, POOJA LAXMINARAYAN
Entity type:Individual
Prefix:
First Name:POOJA
Middle Name:LAXMINARAYAN
Last Name:JANGID
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 1:16 THESTLAND DR.
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545
Mailing Address - Country:US
Mailing Address - Phone:443-310-0409
Mailing Address - Fax:
Practice Address - Street 1:618 GEORGE WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4216
Practice Address - Country:US
Practice Address - Phone:401-475-6599
Practice Address - Fax:401-475-6429
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12950225100000X
RIPT03507225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist