Provider Demographics
NPI:1396951208
Name:KHANOLKAR, REEMA ARUN
Entity type:Individual
Prefix:MISS
First Name:REEMA
Middle Name:ARUN
Last Name:KHANOLKAR
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 1:1289 N LIBERTY ST
Mailing Address - Street 2:APT#1326
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8894
Mailing Address - Country:US
Mailing Address - Phone:208-559-5774
Mailing Address - Fax:
Practice Address - Street 1:1130 ALLUMBAUGH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8700
Practice Address - Country:US
Practice Address - Phone:208-854-8517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2054225100000X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics