Provider Demographics
NPI:1093230385
Name:KHAMBHATI, MANSIBEN RAVI
Entity Type:Individual
Prefix:
First Name:MANSIBEN
Middle Name:RAVI
Last Name:KHAMBHATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MANSI
Other - Middle Name:RAVI
Other - Last Name:KHAMBHATI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1915 KENNEDY DR APT 103
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4730
Mailing Address - Country:US
Mailing Address - Phone:732-789-0308
Mailing Address - Fax:
Practice Address - Street 1:9901 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3357
Practice Address - Country:US
Practice Address - Phone:240-826-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist