Provider Demographics
NPI:1720739527
Name:PANCHOLI, PAYAL
Entity type:Individual
Prefix:
First Name:PAYAL
Middle Name:
Last Name:PANCHOLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAYAL
Other - Middle Name:DAKSHESH
Other - Last Name:PANCHOLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3610 147TH PL NE APT B14
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3574
Mailing Address - Country:US
Mailing Address - Phone:224-602-2126
Mailing Address - Fax:
Practice Address - Street 1:148 102ND AVE SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6197
Practice Address - Country:US
Practice Address - Phone:425-298-3979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61096666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist