Provider Demographics
| NPI: | 1760967483 |
|---|---|
| Name: | GITTHAM, NAZNEEN K |
| Entity Type: | Individual |
| Prefix: | |
| First Name: | NAZNEEN |
| Middle Name: | K |
| Last Name: | GITTHAM |
| 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: | 5428 BARLBY DR BLDG 17 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | INDIANAPOLIS |
| Mailing Address - State: | IN |
| Mailing Address - Zip Code: | 46237-8318 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 317-565-9131 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 4740 KINGSWAY DR |
| Practice Address - Street 2: | |
| Practice Address - City: | INDIANAPOLIS |
| Practice Address - State: | IN |
| Practice Address - Zip Code: | 46205-1521 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 317-466-1000 |
| Practice Address - Fax: | |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2018-09-27 |
| Last Update Date: | 2020-12-04 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 225100000X, 2251C2600X, 2251E1200X, 2251E1300X, 2251H1200X, 2251G0304X, 2251N0400X, 2251S0007X, 2251X0800X, 225200000X | ||
| MA | 24699 | 225100000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
| No | 2251C2600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Cardiopulmonary |
| No | 2251E1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Ergonomics |
| No | 2251E1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Electrophysiology, Clinical |
| No | 2251H1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand |
| No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
| No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology |
| No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports |
| No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
