Provider Demographics
NPI:1194939017
Name:WADHWA, MADHU MANOHAR (PTO)
Entity type:Individual
Prefix:MRS
First Name:MADHU
Middle Name:MANOHAR
Last Name:WADHWA
Suffix:
Gender:F
Credentials:PTO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SAN MATEO WAY
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1034
Mailing Address - Country:US
Mailing Address - Phone:949-760-9566
Mailing Address - Fax:
Practice Address - Street 1:REHAB ALLIANCE, 23271 VERDUGO DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:LAGUNA HILLA
Practice Address - State:CA
Practice Address - Zip Code:92653-1347
Practice Address - Country:US
Practice Address - Phone:949-707-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist