Provider Demographics
NPI:1528490844
Name:ASEEJA, POOJA (R P T)
Entity type:Individual
Prefix:
First Name:POOJA
Middle Name:
Last Name:ASEEJA
Suffix:
Gender:F
Credentials:R P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N ROCK RD
Mailing Address - Street 2:615
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1743
Mailing Address - Country:US
Mailing Address - Phone:219-455-2387
Mailing Address - Fax:
Practice Address - Street 1:2114 N 127TH ST E
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3003
Practice Address - Country:US
Practice Address - Phone:316-500-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist