Provider Demographics
NPI:1225071590
Name:BAKANI, DJOANA CLARA H (PT)
Entity Type:Individual
Prefix:MISS
First Name:DJOANA
Middle Name:CLARA H
Last Name:BAKANI
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 1:20 BYRAM SHORE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6926
Mailing Address - Country:US
Mailing Address - Phone:203-252-6989
Mailing Address - Fax:203-883-6013
Practice Address - Street 1:67 HOLLY HILL LN STE 101
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6072
Practice Address - Country:US
Practice Address - Phone:203-252-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0285852251P0200X
CT007561225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTANC866OtherOXFORD ORTHONET PROVIDER