Provider Demographics
NPI:1346592870
Name:GANDHALE, RATI BHIWA (MPT)
Entity Type:Individual
Prefix:MISS
First Name:RATI
Middle Name:BHIWA
Last Name:GANDHALE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6205 CORNWALLIS DR
Mailing Address - Street 2:APT # 3B
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-8384
Mailing Address - Country:US
Mailing Address - Phone:940-224-6746
Mailing Address - Fax:
Practice Address - Street 1:400 W 7TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MANCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46962-1199
Practice Address - Country:US
Practice Address - Phone:260-982-8616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010297A225100000X
MI5501014930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist