Provider Demographics
NPI:1679210975
Name:BHANDARU, SAKUNTALA NISHA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SAKUNTALA
Middle Name:NISHA
Last Name:BHANDARU
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 W SLAUSON AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6588
Mailing Address - Country:US
Mailing Address - Phone:310-912-7442
Mailing Address - Fax:
Practice Address - Street 1:5601 W SLAUSON AVE STE 125
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6588
Practice Address - Country:US
Practice Address - Phone:310-912-7442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304916225100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program