Provider Demographics
NPI:1609577626
Name:VANKAWALA, TANVI RAJENDRA (DPT)
Entity Type:Individual
Prefix:
First Name:TANVI
Middle Name:RAJENDRA
Last Name:VANKAWALA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 BEHRENS CT
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-4349
Mailing Address - Country:US
Mailing Address - Phone:817-550-3069
Mailing Address - Fax:
Practice Address - Street 1:5615 COLLEYVILLE BLVD STE 130
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6030
Practice Address - Country:US
Practice Address - Phone:817-576-0995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1372246225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist