Healthcare Provider Details

I. General information

NPI: 1386388304
Provider Name (Legal Business Name): HIMA DILIP KOTHARI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 06/03/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1967B WEST SREET
ANNAPOLIS MD
21401
US

IV. Provider business mailing address

7050 SOUTHMOOR ST UNIT 4204
HANOVER MD
21076-2139
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-3136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number27372
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: