Provider Demographics
NPI:1609370956
Name:BHASHYAM, KARTHIK (PT)
Entity Type:Individual
Prefix:
First Name:KARTHIK
Middle Name:
Last Name:BHASHYAM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3752 80TH ST APT 5C
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-9008
Mailing Address - Country:US
Mailing Address - Phone:859-420-3461
Mailing Address - Fax:
Practice Address - Street 1:16 GARDENIA LN
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-2009
Practice Address - Country:US
Practice Address - Phone:347-561-0355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist