Provider Demographics
NPI:1548512775
Name:DHERAI, BHAKTI (PT)
Entity type:Individual
Prefix:MS
First Name:BHAKTI
Middle Name:
Last Name:DHERAI
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 1:4370 KISSENA BLVD
Mailing Address - Street 2:APT 27N
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3769
Mailing Address - Country:US
Mailing Address - Phone:412-478-9061
Mailing Address - Fax:
Practice Address - Street 1:4370 KISSENA BLVD
Practice Address - Street 2:APT 27N
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3769
Practice Address - Country:US
Practice Address - Phone:412-478-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035622208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation