Healthcare Provider Details

I. General information

NPI: 1972104594
Provider Name (Legal Business Name): AYURBLISS PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 N SAN MATEO DR
SAN MATEO CA
94401-2417
US

IV. Provider business mailing address

872 GULL AVE
FOSTER CITY CA
94404-1428
US

V. Phone/Fax

Practice location:
  • Phone: 949-293-2950
  • Fax:
Mailing address:
  • Phone: 949-293-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RUCHA KELKAR
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 949-293-2950