Provider Demographics
NPI:1811673981
Name:RAKHOLIA, BANSI (PT)
Entity type:Individual
Prefix:
First Name:BANSI
Middle Name:
Last Name:RAKHOLIA
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 1:17525 HIGHWAY 99 STE C
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3105
Mailing Address - Country:US
Mailing Address - Phone:206-895-9620
Mailing Address - Fax:
Practice Address - Street 1:17525 HIGHWAY 99 STE C
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-3105
Practice Address - Country:US
Practice Address - Phone:206-895-9620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61439155225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist