MEDICARE: MRS. ANUSHA MADANAMOHAN PHYSICAL THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	2251G0304X	Geriatric Physical Therapist	P15694	NC

General Provider Information

NPI Number	:	1285002253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANUSHA MADANAMOHAN PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	9604 WOBURN RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-1967
Country	:	US
Telephone Number	:	980-322-7374
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 SANDY PORTER RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-3695
Country	:	US
Telephone Number	:	704-583-0430
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2015
Last Update Date	:	04/23/2024

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