Provider Demographics
NPI:1508331281
Name:RACHWANI PARSHOTAM, JAYA
Entity Type:Individual
Prefix:
First Name:JAYA
Middle Name:
Last Name:RACHWANI PARSHOTAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10440 QUEENS BLVD APT 19W
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3657
Mailing Address - Country:US
Mailing Address - Phone:541-974-8147
Mailing Address - Fax:
Practice Address - Street 1:10440 QUEENS BLVD APT 19W
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3657
Practice Address - Country:US
Practice Address - Phone:541-974-8147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0429312251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics