Healthcare Provider Details

I. General information

NPI: 1407726458
Provider Name (Legal Business Name): AGEWELL PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4818 GOLDEN FOOTHILL PKWY UNIT 1
EL DORADO HILLS CA
95762-9825
US

IV. Provider business mailing address

4818 GOLDEN FOOTHILL PKWY UNIT 1
EL DORADO HILLS CA
95762-9825
US

V. Phone/Fax

Practice location:
  • Phone: 916-906-4103
  • Fax:
Mailing address:
  • Phone: 916-906-4103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANU DURGA ANNPOORNA PIDIKITI
Title or Position: CEO
Credential:
Phone: 916-906-4103