Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 05008477A | IN |
Y | 2251C2600X | Cardiopulmonary | 05008477A | IN |
NPI | 1477009231 |
---|---|
Provider Name | Archana Kanetkar |
First Address | Indianapolis, IN 46202-5306 |
Second Address | Indianapolis, IN 46202-1239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2016 |
Last Update Date | 02/02/2017 |