Healthcare Provider Details

I. General information

NPI: 1669737342
Provider Name (Legal Business Name): MAHESH SUBHASH MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S BOEHNE CAMP RD
EVANSVILLE IN
47712-3101
US

IV. Provider business mailing address

6655 OAKLAND CT
NEWBURGH IN
47630-9128
US

V. Phone/Fax

Practice location:
  • Phone: 812-423-7468
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number05010156A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: