Provider Demographics
NPI:1053334664
Name:GORDHAN, DHARMESH ISHWAR (PT)
Entity Type:Individual
Prefix:MR
First Name:DHARMESH
Middle Name:ISHWAR
Last Name:GORDHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 STATHAM BLVD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-3901
Mailing Address - Country:US
Mailing Address - Phone:805-293-6213
Mailing Address - Fax:
Practice Address - Street 1:2051 STATHAM BLVD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-3901
Practice Address - Country:US
Practice Address - Phone:805-293-6213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 328432251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 32843OtherPT BOARD LICENSE