Provider Demographics
NPI:1497066872
Name:JAIN, MAYANK (PT)
Entity Type:Individual
Prefix:
First Name:MAYANK
Middle Name:
Last Name:JAIN
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 1:15 OAKMONT PL
Mailing Address - Street 2:# 216
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-6904
Mailing Address - Country:US
Mailing Address - Phone:817-675-6869
Mailing Address - Fax:
Practice Address - Street 1:12803 LENOVER STREET
Practice Address - Street 2:THE WATERS OF DILLSBORO-ROSS
Practice Address - City:DILLSBORO
Practice Address - State:IN
Practice Address - Zip Code:47018
Practice Address - Country:US
Practice Address - Phone:812-432-5226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010235A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist