Provider Demographics
NPI:1336277672
Name:RAWAL, EKTA S (MA)
Entity type:Individual
Prefix:
First Name:EKTA
Middle Name:S
Last Name:RAWAL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:EAKTA
Other - Middle Name:K
Other - Last Name:LAKHANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:78 RENFIELD DR
Mailing Address - Street 2:PRINCETON
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6263
Mailing Address - Country:US
Mailing Address - Phone:609-945-4928
Mailing Address - Fax:
Practice Address - Street 1:2333 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:MERCERVILLE
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1946
Practice Address - Country:US
Practice Address - Phone:732-491-6547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01067300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist