Provider Demographics
NPI:1538695028
Name:VACHHANI, NIKITA
Entity Type:Individual
Prefix:
First Name:NIKITA
Middle Name:
Last Name:VACHHANI
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 1:17106 NE 45TH ST
Mailing Address - Street 2:APT # 10
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5631
Mailing Address - Country:US
Mailing Address - Phone:858-564-3191
Mailing Address - Fax:
Practice Address - Street 1:3003 W CASINO RD
Practice Address - Street 2:MC 0Y30 BUILDING 40-421
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-1910
Practice Address - Country:US
Practice Address - Phone:425-342-4790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60528199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist