Provider Demographics
NPI:1376972240
Name:PATHAN, SARVARKHAN FIROZ (PT)
Entity Type:Individual
Prefix:MR
First Name:SARVARKHAN
Middle Name:FIROZ
Last Name:PATHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5021 ELTHA DR
Mailing Address - Street 2:APT C
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-1120
Mailing Address - Country:US
Mailing Address - Phone:347-553-8801
Mailing Address - Fax:
Practice Address - Street 1:5021 ELTHA DR
Practice Address - Street 2:APT C
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-1120
Practice Address - Country:US
Practice Address - Phone:347-553-8801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035670225100000X
NC14947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist