MEDICARE: AGEWELL PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1548139108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGEWELL PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	8254 TREVI WAY
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-4182
Country	:	US
Telephone Number	:	916-906-4103
Fax Number	:

Provider Business Practice Location Address
First Line	:	8254 TREVI WAY
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-4182
Country	:	US
Telephone Number	:	916-906-4103
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANU DURGA ANNPOORNA PIDIKITI
Credential	:
Telephone Number	:	916-906-4103

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	12/12/2025

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Directions to “AGEWELL PHYSICAL THERAPY ” Practice Location

Language	Start Address	Practice Location

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