Provider Demographics
NPI:1124694690
Name:GHETIYA, PALAK (DPT, CSCS)
Entity type:Individual
Prefix:DR
First Name:PALAK
Middle Name:
Last Name:GHETIYA
Suffix:
Gender:F
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4528 WILLOW ROCK LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4332
Mailing Address - Country:US
Mailing Address - Phone:860-299-4971
Mailing Address - Fax:
Practice Address - Street 1:1115 U ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-7520
Practice Address - Country:US
Practice Address - Phone:202-897-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT200001218225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist