Healthcare Provider Details

I. General information

NPI: 1457924714
Provider Name (Legal Business Name): VARUNDEEP KOHLI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 W FAIRHAVEN AVE
BURLINGTON WA
98233-1153
US

IV. Provider business mailing address

250 G ST
BLAINE WA
98230-4019
US

V. Phone/Fax

Practice location:
  • Phone: 360-755-9111
  • Fax: 360-755-1320
Mailing address:
  • Phone: 360-332-8167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: