Provider Demographics
NPI:1922675479
Name:KOTHARI, NEHAL (PT)
Entity Type:Individual
Prefix:
First Name:NEHAL
Middle Name:
Last Name:KOTHARI
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 1:43285 POLO CIRCLE
Mailing Address - Street 2:APT #6
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313
Mailing Address - Country:US
Mailing Address - Phone:313-420-7074
Mailing Address - Fax:
Practice Address - Street 1:17200 E 10 MILD RD
Practice Address - Street 2:SUITE 137
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021
Practice Address - Country:US
Practice Address - Phone:269-589-9659
Practice Address - Fax:888-845-5090
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501020001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist