Provider Demographics
NPI:1629155395
Name:GANDBHIR, DISHA S (PT)
Entity Type:Individual
Prefix:
First Name:DISHA
Middle Name:S
Last Name:GANDBHIR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DISHA
Other - Middle Name:A
Other - Last Name:TELANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:31 OLD ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1714
Mailing Address - Country:US
Mailing Address - Phone:203-740-0020
Mailing Address - Fax:203-775-0238
Practice Address - Street 1:90 GROVE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4114
Practice Address - Country:US
Practice Address - Phone:203-431-8471
Practice Address - Fax:203-438-9543
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist