Provider Demographics
NPI:1205372018
Name:BHANTI, NITIN P (LCO)
Entity type:Individual
Prefix:
First Name:NITIN
Middle Name:P
Last Name:BHANTI
Suffix:
Gender:M
Credentials:LCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99283
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-1383
Mailing Address - Country:US
Mailing Address - Phone:682-885-6294
Mailing Address - Fax:682-885-5606
Practice Address - Street 1:13 PRESTIGE CIR STE 180
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3453
Practice Address - Country:US
Practice Address - Phone:214-596-9508
Practice Address - Fax:214-596-9147
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1840222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist