Provider Demographics
NPI:1174016174
Name:UPASANI, ISHWARI SANJAY
Entity Type:Individual
Prefix:
First Name:ISHWARI
Middle Name:SANJAY
Last Name:UPASANI
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 1:807 3RD AVE N APT 24
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3771
Mailing Address - Country:US
Mailing Address - Phone:352-410-2045
Mailing Address - Fax:
Practice Address - Street 1:3221 EASTLAKE AVE E STE 110
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-7125
Practice Address - Country:US
Practice Address - Phone:206-405-1864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60571830225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist