Provider Demographics
NPI:1316984891
Name:KHANDEKAR, GAURI SHIRISH (MHS, MS, PT)
Entity type:Individual
Prefix:
First Name:GAURI
Middle Name:SHIRISH
Last Name:KHANDEKAR
Suffix:
Gender:F
Credentials:MHS, MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 FACTORIA BLVD SE STE 401
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-5259
Mailing Address - Country:US
Mailing Address - Phone:425-562-1920
Mailing Address - Fax:425-562-0054
Practice Address - Street 1:4122 FACTORIA BLVD SE STE 401
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-5259
Practice Address - Country:US
Practice Address - Phone:425-562-1920
Practice Address - Fax:425-562-0054
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012776225100000X
WAPT600472882251X0800X
IL0700156212251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N72320OtherMEDICARE GROUP #
MI650F410180OtherBLUE CARE NETWORK
MI650F410180OtherBCBS OF MI PROVIDER #
MI650F410180OtherBCBS OF MI PROVIDER #
MI650F410180OtherBLUE CARE NETWORK