Provider Demographics
NPI:1275022253
Name:MAHADEVKAR, MANASI (PT)
Entity Type:Individual
Prefix:
First Name:MANASI
Middle Name:
Last Name:MAHADEVKAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MANASI
Other - Middle Name:
Other - Last Name:VAZE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:889 ALFRED CT
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3371
Mailing Address - Country:US
Mailing Address - Phone:979-587-4664
Mailing Address - Fax:
Practice Address - Street 1:889 ALFRED CT
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3371
Practice Address - Country:US
Practice Address - Phone:979-587-4664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-06
Last Update Date:2018-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1255850208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation