Provider Demographics
NPI:1760042204
Name:AMBARDEKAR, PAURAVI AMOL (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:PAURAVI
Middle Name:AMOL
Last Name:AMBARDEKAR
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:PAURAVI
Other - Middle Name:VISHWAS
Other - Last Name:BIDKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:509 OLIVE WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3263
Mailing Address - Country:US
Mailing Address - Phone:206-860-2210
Mailing Address - Fax:206-860-4461
Practice Address - Street 1:509 OLIVE WAY STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3263
Practice Address - Country:US
Practice Address - Phone:206-329-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60183967225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist