Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 12615 | WI |
N | 2251E1300X | Electrophysiology, Clinical | 12615-24 | WI |
NPI | 1912365081 |
---|---|
Provider Name | Khushi Goyal |
First Address | Milwaukee, WI 53215-2843 |
Second Address | Menomonee Falls, WI 53051-2810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2016 |
Last Update Date | 03/01/2022 |