Provider Demographics
NPI:1831944875
Name:DIPENDRA GAUTAM PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:DIPENDRA GAUTAM PHYSICAL THERAPY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DIPENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUTAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:703-626-9334
Mailing Address - Street 1:7942 N MAPLE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0293
Mailing Address - Country:US
Mailing Address - Phone:595-396-4681
Mailing Address - Fax:
Practice Address - Street 1:7942 N MAPLE AVE STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0293
Practice Address - Country:US
Practice Address - Phone:559-396-4681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty