Provider Demographics
NPI:1245502491
Name:GOREGAONKAR, NEHA
Entity type:Individual
Prefix:
First Name:NEHA
Middle Name:
Last Name:GOREGAONKAR
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 1:13500 CHENAL PKWY
Mailing Address - Street 2:APT # 1802
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-5389
Mailing Address - Country:US
Mailing Address - Phone:501-837-4799
Mailing Address - Fax:
Practice Address - Street 1:13500 CHENAL PKWY
Practice Address - Street 2:APT # 1802
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-5389
Practice Address - Country:US
Practice Address - Phone:501-837-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3178225100000X
MI5501014005225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist