Provider Demographics
NPI:1164611042
Name:SAXENA, GAURAV (PT)
Entity Type:Individual
Prefix:
First Name:GAURAV
Middle Name:
Last Name:SAXENA
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:PO BOX 208706
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-8706
Mailing Address - Country:US
Mailing Address - Phone:615-308-3560
Mailing Address - Fax:
Practice Address - Street 1:101 MARKET PLACE BLVD
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-2236
Practice Address - Country:US
Practice Address - Phone:470-210-1164
Practice Address - Fax:470-344-1208
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist