Healthcare Provider Details

I. General information

NPI: 1003554155
Provider Name (Legal Business Name): AVANI ASHWIN VORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E CALAVERAS BLVD STE 112
MILPITAS CA
95035-7708
US

IV. Provider business mailing address

430 MONTAGUE EXPY UNIT 20
MILPITAS CA
95035-6839
US

V. Phone/Fax

Practice location:
  • Phone: 408-934-4700
  • Fax:
Mailing address:
  • Phone: 510-990-1718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT296579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: