Provider Demographics
NPI:1073205191
Name:KOTHARI, MEERA
Entity Type:Individual
Prefix:
First Name:MEERA
Middle Name:
Last Name:KOTHARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16261 REDMOND WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3833
Mailing Address - Country:US
Mailing Address - Phone:425-881-3001
Mailing Address - Fax:
Practice Address - Street 1:16261 REDMOND WAY STE 100
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3833
Practice Address - Country:US
Practice Address - Phone:425-881-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61325614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist