Provider Demographics
NPI:1639867393
Name:MOHITA, MAN
Entity Type:Individual
Prefix:
First Name:MAN
Middle Name:
Last Name:MOHITA
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 1:10980 GRANTCHESTER WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6097
Mailing Address - Country:US
Mailing Address - Phone:877-772-6505
Mailing Address - Fax:
Practice Address - Street 1:4240 ALTAMONT PL STE 101
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3052
Practice Address - Country:US
Practice Address - Phone:301-638-8542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050108225100000X
MD29399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist