Provider Demographics
NPI:1386607943
Name:MOHAN, ANITHA (MPT)
Entity type:Individual
Prefix:MS
First Name:ANITHA
Middle Name:
Last Name:MOHAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 MAXIM LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5531
Mailing Address - Country:US
Mailing Address - Phone:440-263-4829
Mailing Address - Fax:
Practice Address - Street 1:7277 SMITHS MILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8195
Practice Address - Country:US
Practice Address - Phone:614-855-8030
Practice Address - Fax:614-855-8304
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4783225100000X
OH10763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist