Provider Demographics
NPI:1467631820
Name:DAVE, CHARU (RPT)
Entity type:Individual
Prefix:MS
First Name:CHARU
Middle Name:
Last Name:DAVE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 MOWRY AVE
Mailing Address - Street 2:SUITE 118-A
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1737
Mailing Address - Country:US
Mailing Address - Phone:510-790-0178
Mailing Address - Fax:510-790-1197
Practice Address - Street 1:1895 MOWRY AVE
Practice Address - Street 2:SUITE 118-A
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1737
Practice Address - Country:US
Practice Address - Phone:510-790-0178
Practice Address - Fax:510-790-1197
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31961ZMedicare PIN