Healthcare Provider Details

I. General information

NPI: 1043884729
Provider Name (Legal Business Name): NEHA BHAGWAT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 228TH ST SW
BOTHELL WA
98021-9733
US

IV. Provider business mailing address

3528 216TH PL SE
BOTHELL WA
98021-3543
US

V. Phone/Fax

Practice location:
  • Phone: 425-481-8500
  • Fax:
Mailing address:
  • Phone: 480-544-5643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number60267347
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: