Healthcare Provider Details

I. General information

NPI: 1083397145
Provider Name (Legal Business Name): ANKITA SHUKLA PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4077 FENNEL TER
FREMONT CA
94538-4094
US

IV. Provider business mailing address

4077 FENNEL TER
FREMONT CA
94538-4094
US

V. Phone/Fax

Practice location:
  • Phone: 734-330-1285
  • Fax:
Mailing address:
  • Phone: 734-330-1285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANKITA SHUKLA
Title or Position: CEO
Credential:
Phone: 734-330-1285