Provider Demographics
NPI:1417389123
Name:JAKATDAR, PALLAVI (PT)
Entity Type:Individual
Prefix:
First Name:PALLAVI
Middle Name:
Last Name:JAKATDAR
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:310-826-4114
Practice Address - Street 1:3105 ALDERWOOD MALL BLVD STE H
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4703
Practice Address - Country:US
Practice Address - Phone:425-582-5902
Practice Address - Fax:425-412-2980
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist