Provider Demographics
NPI:1447894761
Name:GUPTA, RADHIKA RAJENDRA (PT)
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:RAJENDRA
Last Name:GUPTA
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:PO BOX 10016
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-3216
Mailing Address - Country:US
Mailing Address - Phone:909-883-5069
Mailing Address - Fax:909-883-5473
Practice Address - Street 1:1181 E HIGHLAND AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4605
Practice Address - Country:US
Practice Address - Phone:909-883-5069
Practice Address - Fax:909-883-5473
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY44780225100000X
CA300432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist