Provider Demographics
NPI:1649727983
Name:WONG, ANISHA MUKHI (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANISHA
Middle Name:MUKHI
Last Name:WONG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ANISHA
Other - Middle Name:
Other - Last Name:MUKHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:706-887-5665
Mailing Address - Fax:706-887-5672
Practice Address - Street 1:3709 GENTIAN BLVD STE 12
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-1165
Practice Address - Country:US
Practice Address - Phone:706-887-5665
Practice Address - Fax:706-887-5672
Is Sole Proprietor?:No
Enumeration Date:2016-09-03
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist