Provider Demographics
NPI:1861146664
Name:GOLCHIN, FERESHTEH
Entity type:Individual
Prefix:
First Name:FERESHTEH
Middle Name:
Last Name:GOLCHIN
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 1:23960 KATY FWY STE 100
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0893
Mailing Address - Country:US
Mailing Address - Phone:281-644-7880
Mailing Address - Fax:
Practice Address - Street 1:23960 KATY FWY STE 100
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-0893
Practice Address - Country:US
Practice Address - Phone:281-644-7880
Practice Address - Fax:281-644-7888
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2037497225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00619417OtherDRIVER LICENSE