Healthcare Provider Details

I. General information

NPI: 1740699727
Provider Name (Legal Business Name): DHARA VIRANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W WILLIAM CANNON DR 409
AUSTIN TX
78745-5257
US

IV. Provider business mailing address

8808 VANTAGE POINT DR
AUSTIN TX
78737-1235
US

V. Phone/Fax

Practice location:
  • Phone: 512-852-8434
  • Fax:
Mailing address:
  • Phone: 512-659-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1238112
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: