Provider Demographics
NPI:1437495405
Name:PANDYA, MOHINI (MSPT)
Entity Type:Individual
Prefix:
First Name:MOHINI
Middle Name:
Last Name:PANDYA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16647 NW AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7753
Mailing Address - Country:US
Mailing Address - Phone:503-866-3442
Mailing Address - Fax:
Practice Address - Street 1:16647 NW AVONDALE DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7753
Practice Address - Country:US
Practice Address - Phone:503-866-3442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist