Provider Demographics
NPI:1497278899
Name:MAHESWARAN, GOKULAWATHANI
Entity Type:Individual
Prefix:
First Name:GOKULAWATHANI
Middle Name:
Last Name:MAHESWARAN
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 1:11205 ELAM DR
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-2356
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:REGENCY HEALTHCARE AND REHABILITATION CENTER
Practice Address - Street 2:801, NORTH BROOM STREET
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806
Practice Address - Country:US
Practice Address - Phone:302-652-8400
Practice Address - Fax:302-652-8811
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027233225100000X
DEJ1-0003665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist