Provider Demographics
NPI:1770037780
Name:BROWN, MAHITHA REDDY (DPT, ATC, NCPT)
Entity Type:Individual
Prefix:
First Name:MAHITHA
Middle Name:REDDY
Last Name:BROWN
Suffix:
Gender:F
Credentials:DPT, ATC, NCPT
Other - Prefix:
Other - First Name:MAHITHA
Other - Middle Name:
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 SUMMIT AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1763
Mailing Address - Country:US
Mailing Address - Phone:201-305-0130
Mailing Address - Fax:
Practice Address - Street 1:160 SUMMIT AVE STE 204
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1763
Practice Address - Country:US
Practice Address - Phone:201-305-0130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01980600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist