Provider Demographics
NPI:1992886501
Name:HEREKAR, RAGINI SATISH (PT)
Entity type:Individual
Prefix:MRS
First Name:RAGINI
Middle Name:SATISH
Last Name:HEREKAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3361 EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-3527
Mailing Address - Country:US
Mailing Address - Phone:650-947-9646
Mailing Address - Fax:
Practice Address - Street 1:39180 FARWELL DR,
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-585-2545
Practice Address - Fax:866-484-5954
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT116070Medicare PIN