Provider Demographics
NPI:1386104008
Name:BHAGAT, KHUSHBOO (PT)
Entity type:Individual
Prefix:
First Name:KHUSHBOO
Middle Name:
Last Name:BHAGAT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3800
Mailing Address - Country:US
Mailing Address - Phone:201-243-9291
Mailing Address - Fax:201-243-9923
Practice Address - Street 1:11 W 25TH ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3800
Practice Address - Country:US
Practice Address - Phone:201-243-9291
Practice Address - Fax:201-243-9923
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01849800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist