Provider Demographics
NPI:1518949023
Name:MERCHANT, GAURAVI P (PT)
Entity Type:Individual
Prefix:
First Name:GAURAVI
Middle Name:P
Last Name:MERCHANT
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 1:12217 SANTA MONICA BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2589
Mailing Address - Country:US
Mailing Address - Phone:310-309-3721
Mailing Address - Fax:310-309-3724
Practice Address - Street 1:12217 SANTA MONICA BLVD STE 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-309-3721
Practice Address - Fax:310-309-3724
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist