Healthcare Provider Details

I. General information

NPI: 1447229000
Provider Name (Legal Business Name): MANMOHAN S KHOKHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 JOHNSTON WILLIS DRIVE 5 E IN PT REHAB
RICHMOND VA
23235-4722
US

IV. Provider business mailing address

1776 WOODSTEAD CT STE 208
THE WOODLANDS TX
77380-1480
US

V. Phone/Fax

Practice location:
  • Phone: 804-467-2258
  • Fax: 804-378-2248
Mailing address:
  • Phone: 877-749-7428
  • Fax: 512-628-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101039867
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: