MEDICARE: NEHA GOREGAONKAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT3178	AR
2	225100000X	Physical Therapist	5501014005	MI

General Provider Information

NPI Number	:	1245502491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEHA GOREGAONKAR

Provider Business Mailing Address
First Line	:	13500 CHENAL PKWY
Second Line	:	APT # 1802
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-5389
Country	:	US
Telephone Number	:	501-837-4799
Fax Number	:

Provider Business Practice Location Address
First Line	:	13500 CHENAL PKWY
Second Line	:	APT # 1802
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-5389
Country	:	US
Telephone Number	:	501-837-4799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2012
Last Update Date	:	02/03/2012

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