Basic Information
| Provider Information | |||||||||
| NPI: | 1386917599 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PANCHAL | ||||||||
| FirstName: | BHAVIKA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2104 E BAY DR | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337712323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275870582 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2104 E BAY DR | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337712323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275870582 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2012 | ||||||||
| LastUpdateDate: | 02/17/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 27139 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 033168 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.