Provider Demographics
NPI:1548965700
Name:BRAHMBHATT, KHUSHALI GHANSHYAMBHAI
Entity type:Individual
Prefix:
First Name:KHUSHALI
Middle Name:GHANSHYAMBHAI
Last Name:BRAHMBHATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 CENTRAL AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2336
Mailing Address - Country:US
Mailing Address - Phone:201-238-1338
Mailing Address - Fax:
Practice Address - Street 1:255 E 138TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-6425
Practice Address - Country:US
Practice Address - Phone:718-559-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist