Healthcare Provider Details

I. General information

NPI: 1497578462
Provider Name (Legal Business Name): MONA VACHHANI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE
ATLANTA GA
30308-2212
US

IV. Provider business mailing address

330 ARDMORE CIR NW UNIT C136
ATLANTA GA
30309-1965
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-2387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017070
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: