Provider Demographics
NPI:1962086025
Name:CHALLAGULLA, RUCHIKA RAI (PT)
Entity type:Individual
Prefix:
First Name:RUCHIKA
Middle Name:RAI
Last Name:CHALLAGULLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RUCHIKA
Other - Middle Name:RAI
Other - Last Name:CHALASANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10505 SEA PEARL CV UNIT 11
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-8745
Mailing Address - Country:US
Mailing Address - Phone:630-687-0158
Mailing Address - Fax:
Practice Address - Street 1:10505 SEA PEARL CV UNIT 11
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-8745
Practice Address - Country:US
Practice Address - Phone:630-687-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA402442251H1300X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251H1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHuman Factors
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF7830716OtherDMV