Provider Demographics
NPI:1629758321
Name:GANESH, MADHUVANTHI (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MADHUVANTHI
Middle Name:
Last Name:GANESH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WITMAN DR
Mailing Address - Street 2:
Mailing Address - City:BREINIGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18031-4119
Mailing Address - Country:US
Mailing Address - Phone:610-597-3569
Mailing Address - Fax:
Practice Address - Street 1:90 S COMMERCE WAY STE 100
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8611
Practice Address - Country:US
Practice Address - Phone:484-820-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1377821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist