Healthcare Provider Details

I. General information

NPI: 1114042504
Provider Name (Legal Business Name): SENTHIL V. MUKUNTHAN P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 S EMERSON AVE STE 100
INDIANAPOLIS IN
46237-8631
US

IV. Provider business mailing address

8051 S EMERSON AVE STE 100
INDIANAPOLIS IN
46237-8631
US

V. Phone/Fax

Practice location:
  • Phone: 317-528-8111
  • Fax: 317-528-8065
Mailing address:
  • Phone: 317-528-8111
  • Fax: 317-528-8065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05003375A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: