Basic Information
Provider Information
NPI: 1013565258
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DHURI
FirstName: SAYALI
MiddleName: ARUNKUMAR
NamePrefix:  
NameSuffix:  
Credential: PT DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 600 CENTRAL AVE STE C
Address2:  
City: LAKE ELSINORE
State: CA
PostalCode: 925302740
CountryCode: US
TelephoneNumber: 9516969353
FaxNumber:  
Practice Location
Address1: 23100 EUCALYPTUS AVE STE C
Address2:  
City: MORENO VALLEY
State: CA
PostalCode: 925535439
CountryCode: US
TelephoneNumber: 9513791500
FaxNumber: 9513791501
Other Information
ProviderEnumerationDate: 08/30/2019
LastUpdateDate: 04/18/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/18/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X296710CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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