Healthcare Provider Details

I. General information

NPI: 1750740387
Provider Name (Legal Business Name): ANISHA AJGAONKAR P.T., M.H.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/22/2025
Certification Date: 02/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 MARTIN LUTHER KING DR
HAYWARD CA
94541-4397
US

IV. Provider business mailing address

1335 MARTIN LUTHER KING DR
HAYWARD CA
94541-4397
US

V. Phone/Fax

Practice location:
  • Phone: 408-269-0701
  • Fax:
Mailing address:
  • Phone: 317-313-6186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number295636
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05011766A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number295636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: