Provider Demographics
NPI:1598024259
Name:MOHAN, ASHOK LAL (RPT)
Entity Type:Individual
Prefix:MR
First Name:ASHOK
Middle Name:LAL
Last Name:MOHAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3749 BRAYDEN DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-7797
Mailing Address - Country:US
Mailing Address - Phone:812-760-2348
Mailing Address - Fax:866-774-0493
Practice Address - Street 1:3749 BRAYDEN DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-7797
Practice Address - Country:US
Practice Address - Phone:812-760-2348
Practice Address - Fax:866-774-0493
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005231A225100000X
IL07009728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist