Provider Demographics
NPI:1235776964
Name:LOTHE, GURU ROOPA (PT, RN)
Entity Type:Individual
Prefix:
First Name:GURU ROOPA
Middle Name:
Last Name:LOTHE
Suffix:
Gender:F
Credentials:PT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3038 ALDWYCH CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6942
Mailing Address - Country:US
Mailing Address - Phone:317-403-9670
Mailing Address - Fax:
Practice Address - Street 1:5080 N STATE ROAD 135 STE G
Practice Address - Street 2:
Practice Address - City:BARGERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46106-8931
Practice Address - Country:US
Practice Address - Phone:317-403-9670
Practice Address - Fax:317-893-2675
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004353A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist