Healthcare Provider Details

I. General information

NPI: 1114273117
Provider Name (Legal Business Name): KRISHMA DHOLAKIA P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 ORANGE AVE
LONG BEACH CA
90807-3717
US

IV. Provider business mailing address

4010 ORANGE AVE
LONG BEACH CA
90807-3717
US

V. Phone/Fax

Practice location:
  • Phone: 562-428-3556
  • Fax:
Mailing address:
  • Phone: 562-428-3556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number38560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: