Provider Demographics
NPI:1912107822
Name:KAVEHKAR, PARVIN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:PARVIN
Middle Name:
Last Name:KAVEHKAR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:PARVIN
Other - Middle Name:
Other - Last Name:SHAHIRI BONAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:3305 NORTHLAND DR STE 310
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4989
Mailing Address - Country:US
Mailing Address - Phone:512-275-0282
Mailing Address - Fax:512-275-0281
Practice Address - Street 1:3305 NORTHLAND DR STE 310
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4989
Practice Address - Country:US
Practice Address - Phone:512-275-0282
Practice Address - Fax:512-275-0281
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1065340174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0478OtherMEDICARE