Provider Demographics
NPI:1114340148
Name:CHARASIKA, ITAYI ANN (BS, DPT)
Entity Type:Individual
Prefix:DR
First Name:ITAYI
Middle Name:ANN
Last Name:CHARASIKA
Suffix:
Gender:F
Credentials:BS, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 RAINBOW SPRINGS CT APT 7
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2241
Mailing Address - Country:US
Mailing Address - Phone:502-609-9916
Mailing Address - Fax:
Practice Address - Street 1:9201 RAINBOW SPRINGS CT APT 7
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2241
Practice Address - Country:US
Practice Address - Phone:502-609-9916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02970225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant