MEDICARE: SUJAY R NAIR PT

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	:	1861841769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUJAY R NAIR PT

Provider Business Mailing Address
First Line	:	1518 COFFEE RD STE I
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-3164
Country	:	US
Telephone Number	:	209-576-0888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 COMMERCE AVE
Second Line	:
City	:	ATWATER
State	:	CA
Zip	:	95301-5224
Country	:	US
Telephone Number	:	209-683-1386
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2016
Last Update Date	:	09/28/2020

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Directions to “ SUJAY R NAIR PT” Practice Location

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