Healthcare Provider Details

I. General information

NPI: 1326604893
Provider Name (Legal Business Name): AASHIKA SUSEENDRAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 21ST ST STE R
SACRAMENTO CA
95811-5226
US

IV. Provider business mailing address

12 FAIRMONT DR
COLUMBUS NJ
08022-2354
US

V. Phone/Fax

Practice location:
  • Phone: 609-864-2931
  • Fax:
Mailing address:
  • Phone: 609-864-2931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT027674
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberCA297402
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02166900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: