Healthcare Provider Details

I. General information

NPI: 1154029791
Provider Name (Legal Business Name): SUNITA OGALE MOKADAM PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4590 KNIGHTSBRIDGE BLVD STE 1
COLUMBUS OH
43214-4326
US

IV. Provider business mailing address

2660 CRAFTON PARK
UPPER ARLINGTON OH
43221-3694
US

V. Phone/Fax

Practice location:
  • Phone: 614-453-9866
  • Fax: 614-326-0079
Mailing address:
  • Phone: 206-280-9593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number017848
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: