Provider Demographics
NPI:1164733341
Name:GOPINATH, THARA (M PT)
Entity Type:Individual
Prefix:MRS
First Name:THARA
Middle Name:
Last Name:GOPINATH
Suffix:
Gender:F
Credentials:M PT
Other - Prefix:
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Mailing Address - Street 1:4591 SOUTHWESTERN BLVD
Mailing Address - Street 2:APT U # 4
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-1946
Mailing Address - Country:US
Mailing Address - Phone:408-667-6888
Mailing Address - Fax:
Practice Address - Street 1:845 ROUTES 5 & 20
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081
Practice Address - Country:US
Practice Address - Phone:716-951-7270
Practice Address - Fax:716-951-7271
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY031928-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist