Provider Demographics
NPI:1881200350
Name:MAHESH, POOJA (PTA)
Entity Type:Individual
Prefix:
First Name:POOJA
Middle Name:
Last Name:MAHESH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BUTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2060
Mailing Address - Country:US
Mailing Address - Phone:484-653-7484
Mailing Address - Fax:
Practice Address - Street 1:215 SUGARTOWN RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3137
Practice Address - Country:US
Practice Address - Phone:484-582-0660
Practice Address - Fax:484-582-0666
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE012525208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation