Provider Demographics
NPI:1750037719
Name:GHOSH, RIMA GANDHI
Entity Type:Individual
Prefix:
First Name:RIMA
Middle Name:GANDHI
Last Name:GHOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 GILLETTE FIELD CLOSE
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-0527
Mailing Address - Country:US
Mailing Address - Phone:314-517-7669
Mailing Address - Fax:314-667-5381
Practice Address - Street 1:78 GILLETTE FIELD CLOSE
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-0527
Practice Address - Country:US
Practice Address - Phone:314-517-7669
Practice Address - Fax:314-667-5381
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016032817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist