Provider Demographics
NPI:1356168546
Name:DAXINI, DHARA ASHOKKUMAR (PT)
Entity type:Individual
Prefix:
First Name:DHARA
Middle Name:ASHOKKUMAR
Last Name:DAXINI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DHARA
Other - Middle Name:ASHOK
Other - Last Name:DAXINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6842 RACE TRACK RD STE B
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-3011
Practice Address - Country:US
Practice Address - Phone:240-544-0200
Practice Address - Fax:301-464-1053
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist