Provider Demographics
NPI:1770034811
Name:BAJAJ, DEEPTI (PT)
Entity Type:Individual
Prefix:
First Name:DEEPTI
Middle Name:
Last Name:BAJAJ
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 1:9712 CASTLE PINES DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-3857
Mailing Address - Country:US
Mailing Address - Phone:215-470-1480
Mailing Address - Fax:
Practice Address - Street 1:600 N PEARL STREET
Practice Address - Street 2:SUITE 1050
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-7495
Practice Address - Country:US
Practice Address - Phone:215-470-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1217723225100000X
NY034631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist