Healthcare Provider Details

I. General information

NPI: 1023150331
Provider Name (Legal Business Name): MANISHA B KOTHARI P.T., D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 TWINLAWNS AVE
HICKSVILLE NY
11801-1817
US

IV. Provider business mailing address

33 TWINLAWNS AVE
HICKSVILLE NY
11801-1817
US

V. Phone/Fax

Practice location:
  • Phone: 646-279-3250
  • Fax:
Mailing address:
  • Phone: 646-279-3250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number025459-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: