Provider Demographics
NPI:1952889461
Name:BHANUSHALI, DHAWAL (PT)
Entity Type:Individual
Prefix:
First Name:DHAWAL
Middle Name:
Last Name:BHANUSHALI
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 1:2000 W KETTLEMAN LN STE 106
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-4334
Mailing Address - Country:US
Mailing Address - Phone:209-207-0849
Mailing Address - Fax:209-207-0852
Practice Address - Street 1:2000 W KETTLEMAN LN STE 106
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-4334
Practice Address - Country:US
Practice Address - Phone:209-207-0849
Practice Address - Fax:209-207-0852
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist