Provider Demographics
NPI:1386856094
Name:BHARATHAN, GEETHA
Entity Type:Individual
Prefix:MRS
First Name:GEETHA
Middle Name:
Last Name:BHARATHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 MAIN ST
Mailing Address - Street 2:# 5 A
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-6576
Mailing Address - Country:US
Mailing Address - Phone:732-736-9812
Mailing Address - Fax:
Practice Address - Street 1:94 STEVENS RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1237
Practice Address - Country:US
Practice Address - Phone:732-914-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA010554002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics