Healthcare Provider Details

I. General information

NPI: 1053554048
Provider Name (Legal Business Name): GAURAV KAUSHIK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 E ROMIE LN
SALINAS CA
93901-4208
US

IV. Provider business mailing address

201 MAIN STREET
PHILMONT NY
12565
US

V. Phone/Fax

Practice location:
  • Phone: 831-424-8072
  • Fax:
Mailing address:
  • Phone: 518-672-7408
  • Fax: 518-672-4721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number41470
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number031219
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: