Provider Demographics
NPI:1295017572
Name:MOHITE, RUSHIKESH RAVINDRA (PT)
Entity Type:Individual
Prefix:
First Name:RUSHIKESH
Middle Name:RAVINDRA
Last Name:MOHITE
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 1:750 W 10TH ST
Mailing Address - Street 2:APT 85
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3098
Mailing Address - Country:US
Mailing Address - Phone:317-850-1904
Mailing Address - Fax:
Practice Address - Street 1:3600 W BETHEL AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5407
Practice Address - Country:US
Practice Address - Phone:765-213-3870
Practice Address - Fax:765-213-3888
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010804A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400056878Medicare PIN
NYA400055954Medicare PIN
NYA400056899Medicare PIN
NYA400060445Medicare PIN