Provider Demographics
NPI:1174769020
Name:BAVDEKAR, PREETI (PT)
Entity type:Individual
Prefix:MRS
First Name:PREETI
Middle Name:
Last Name:BAVDEKAR
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 1:15 RAFAILLO DR
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-5628
Mailing Address - Country:US
Mailing Address - Phone:518-459-4505
Mailing Address - Fax:
Practice Address - Street 1:15 RAFAILLO DR
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-5628
Practice Address - Country:US
Practice Address - Phone:518-459-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-24
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022200-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics