Provider Demographics
NPI:1548765597
Name:AGARWAL, PRATIBHA (MPT)
Entity Type:Individual
Prefix:
First Name:PRATIBHA
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:PRATIBHA
Other - Middle Name:
Other - Last Name:RANJAN
Other - Suffix:
Other - Last Name Type:Former Name
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:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:6030 DAYBREAK CIR STE 115
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1624
Practice Address - Country:US
Practice Address - Phone:667-786-7977
Practice Address - Fax:667-200-3683
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist