Provider Demographics
NPI:1396989406
Name:BHATT, FULAVA UTKARSH (PT)
Entity type:Individual
Prefix:
First Name:FULAVA
Middle Name:UTKARSH
Last Name:BHATT
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 1:218 LIVINGSTONE FALLS DR
Mailing Address - Street 2:APARTMENT NUMBER 124
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-5250
Mailing Address - Country:US
Mailing Address - Phone:305-632-8237
Mailing Address - Fax:
Practice Address - Street 1:218 LIVINGSTONE FALLS DR
Practice Address - Street 2:APARTMENT NUMBER 124
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-5250
Practice Address - Country:US
Practice Address - Phone:305-632-8237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7642225100000X
NCP15222225100000X
NY031229-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist