Healthcare Provider Details

I. General information

NPI: 1710507173
Provider Name (Legal Business Name): ASHA J GUMMADI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHA JYOTHI GUMMADI

II. Dates (important events)

Enumeration Date: 04/25/2020
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9595 NEEDLES AVE
FRISCO TX
75035-1514
US

IV. Provider business mailing address

1932 WALNUT PLZ
CARROLLTON TX
75006-5810
US

V. Phone/Fax

Practice location:
  • Phone: 312-420-1654
  • Fax:
Mailing address:
  • Phone: 312-420-1654
  • Fax: 469-892-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT020872
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number1227940
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: