Provider Demographics
NPI:1114042504
Name:MUKUNTHAN, SENTHIL V (PT)
Entity Type:Individual
Prefix:MR
First Name:SENTHIL
Middle Name:V
Last Name:MUKUNTHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8051 S EMERSON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8631
Mailing Address - Country:US
Mailing Address - Phone:317-528-8111
Mailing Address - Fax:317-528-8065
Practice Address - Street 1:8051 S EMERSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8631
Practice Address - Country:US
Practice Address - Phone:317-528-8111
Practice Address - Fax:317-528-8065
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003375A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist