Provider Demographics
NPI:1629317201
Name:GANDHI, NIKISHA (PT)
Entity Type:Individual
Prefix:
First Name:NIKISHA
Middle Name:
Last Name:GANDHI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9182
Mailing Address - Country:US
Mailing Address - Phone:301-805-5006
Mailing Address - Fax:301-805-5004
Practice Address - Street 1:12200 ANNAPOLIS RD
Practice Address - Street 2:SUITE 119
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9182
Practice Address - Country:US
Practice Address - Phone:301-805-5006
Practice Address - Fax:301-805-5004
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-02
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist