Individual
AVIINAASH PASULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
406 W 5TH ST, SAN DIMAS, CA 91773-2014
(312) 734-0776
Mailing address
406 W 5TH ST, SAN DIMAS, CA 91773-2014
(312) 734-0776
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA50248
CA
Other
Enumeration date
12/30/2019
Last updated
12/30/2019
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