Provider Demographics
NPI:1902315237
Name:POTHARAM, ANUPAMA (PTA)
Entity Type:Individual
Prefix:MS
First Name:ANUPAMA
Middle Name:
Last Name:POTHARAM
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 1:2422 UNIVERSITY PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-3645
Mailing Address - Country:US
Mailing Address - Phone:804-716-1527
Mailing Address - Fax:804-716-1563
Practice Address - Street 1:2422 UNIVERSITY PARK BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-3645
Practice Address - Country:US
Practice Address - Phone:804-716-1527
Practice Address - Fax:804-716-1563
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604659225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant