Provider Demographics
NPI:1245485531
Name:PATHAK, AAGNYA
Entity type:Individual
Prefix:
First Name:AAGNYA
Middle Name:
Last Name:PATHAK
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 1:6849 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 102 BUILDIG B1
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6849 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 102 BUILDIG B1
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1610
Practice Address - Country:US
Practice Address - Phone:866-587-9922
Practice Address - Fax:678-587-9993
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist