Healthcare Provider Details

I. General information

NPI: 1912976556
Provider Name (Legal Business Name): MITHUN ANANT JOSHI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 SCIOTO ST RM 108
CINCINNATI OH
45219-2072
US

IV. Provider business mailing address

30 SUTTON PL
CINCINNATI OH
45230-1311
US

V. Phone/Fax

Practice location:
  • Phone: 513-556-3178
  • Fax:
Mailing address:
  • Phone: 919-619-4217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11167
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: