Provider Demographics
NPI:1679960397
Name:MANN, ITINDER KAUR (MPT)
Entity Type:Individual
Prefix:MISS
First Name:ITINDER
Middle Name:KAUR
Last Name:MANN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8749 BROOKE PARK DR APT 108
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5103
Mailing Address - Country:US
Mailing Address - Phone:408-981-1503
Mailing Address - Fax:
Practice Address - Street 1:8749 BROOKE PARK DR APT 108
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5103
Practice Address - Country:US
Practice Address - Phone:408-981-1503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21680225100000X
CT10030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist