Provider Demographics
NPI:1568463271
Name:KSHIRSAGAR, VALLABHA SUDHIR (PT OCS CHT)
Entity Type:Individual
Prefix:MRS
First Name:VALLABHA
Middle Name:SUDHIR
Last Name:KSHIRSAGAR
Suffix:
Gender:F
Credentials:PT OCS CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 GLEN ESTE WITHAMSVILLE ROAD
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245
Mailing Address - Country:US
Mailing Address - Phone:513-753-2133
Mailing Address - Fax:513-753-1804
Practice Address - Street 1:4440 GLEN ESTE WITHAMSVILLE RD
Practice Address - Street 2:SUITE 1500
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245
Practice Address - Country:US
Practice Address - Phone:513-753-2133
Practice Address - Fax:513-753-1804
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 4293225100000X
OH10411001632251H1200X
OH82182251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0815452Medicaid
OH0815452Medicaid
OH0703143Medicare PIN
OHKS0703142Medicare ID - Type Unspecified
OH0703141Medicare PIN
OH0703142Medicare PIN