Provider Demographics
NPI:1811759004
Name:WADHWANI, SEEMA (PTA)
Entity type:Individual
Prefix:
First Name:SEEMA
Middle Name:
Last Name:WADHWANI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30950 RANCHO VIEJO RD STE 225
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1772
Mailing Address - Country:US
Mailing Address - Phone:949-542-5000
Mailing Address - Fax:949-419-2650
Practice Address - Street 1:903 CALLE AMANECER STE 200
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6252
Practice Address - Country:US
Practice Address - Phone:949-388-6552
Practice Address - Fax:949-388-6502
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA50726225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant