Provider Demographics
NPI:1164022463
Name:ANTANI, KAHANI SOURABH (PT)
Entity Type:Individual
Prefix:
First Name:KAHANI
Middle Name:SOURABH
Last Name:ANTANI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 SIR BRINE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5885
Mailing Address - Country:US
Mailing Address - Phone:972-979-9453
Mailing Address - Fax:
Practice Address - Street 1:308 SIR BRINE DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-5885
Practice Address - Country:US
Practice Address - Phone:972-979-9453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty