Basic Information
Provider Information
NPI: 1669667036
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GUPTA
FirstName: JULIE
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SAUNDERS
OtherFirstName: JULIE
OtherMiddleName: ANN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: PT
OtherLastNameType: 5
Mailing Information
Address1: 39400 PASEO PADRE PKWY
Address2:  
City: FREMONT
State: CA
PostalCode: 945382310
CountryCode: US
TelephoneNumber: 8773252776
FaxNumber: 4089454011
Practice Location
Address1: 246 SOBRANTE WAY
Address2:  
City: SUNNYVALE
State: CA
PostalCode: 940864807
CountryCode: US
TelephoneNumber: 4087333670
FaxNumber: 4082457968
Other Information
ProviderEnumerationDate: 09/10/2007
LastUpdateDate: 01/11/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT 28318CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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