Provider Demographics
NPI:1235639519
Name:KHOSA, PANTHJIT
Entity Type:Individual
Prefix:
First Name:PANTHJIT
Middle Name:
Last Name:KHOSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 S BRAWLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CARUTHERS
Mailing Address - State:CA
Mailing Address - Zip Code:93609-9515
Mailing Address - Country:US
Mailing Address - Phone:559-930-4568
Mailing Address - Fax:
Practice Address - Street 1:1519 W YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-5159
Practice Address - Country:US
Practice Address - Phone:209-823-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist