Provider Demographics
NPI:1194233254
Name:GOENKA, CHHAVI
Entity type:Individual
Prefix:
First Name:CHHAVI
Middle Name:
Last Name:GOENKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 DE MARIETTA AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-4407
Mailing Address - Country:US
Mailing Address - Phone:805-418-0592
Mailing Address - Fax:
Practice Address - Street 1:22445 CUPERTINO RD
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-1052
Practice Address - Country:US
Practice Address - Phone:805-418-0592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist