Provider Demographics
NPI:1457924714
Name:KOHLI, VARUNDEEP (PT)
Entity Type:Individual
Prefix:
First Name:VARUNDEEP
Middle Name:
Last Name:KOHLI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 G ST
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-4019
Mailing Address - Country:US
Mailing Address - Phone:360-332-8167
Mailing Address - Fax:
Practice Address - Street 1:135 W FAIRHAVEN AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1153
Practice Address - Country:US
Practice Address - Phone:360-755-9111
Practice Address - Fax:360-755-1320
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2188065Medicaid