Provider Demographics
NPI:1205372018
Name:BHANTI, NITIN (CO,LO)
Entity Type:Individual
Prefix:MR
First Name:NITIN
Middle Name:
Last Name:BHANTI
Suffix:
Gender:M
Credentials:CO,LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 HARRY HINES BLVD
Mailing Address - Street 2:STE. V2.302
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9091
Mailing Address - Country:US
Mailing Address - Phone:214-645-8250
Mailing Address - Fax:214-645-8251
Practice Address - Street 1:6011 HARRY HINES BLVD
Practice Address - Street 2:STE. V2.302
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9091
Practice Address - Country:US
Practice Address - Phone:214-645-8250
Practice Address - Fax:214-645-8251
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213.000300222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist