Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | P15694 | NC |
NPI | 1285002253 |
---|---|
Provider Name | Mrs. Anusha Madanamohan |
First Address | Charlotte, NC 28277-1967 |
Second Address | Charlotte, NC 28273-3695 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2015 |
Last Update Date | 13/11/2021 |