Provider Demographics
NPI:1902800477
Name:PANDYA, MOHINI M (PT)
Entity Type:Individual
Prefix:
First Name:MOHINI
Middle Name:M
Last Name:PANDYA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3493
Mailing Address - Country:US
Mailing Address - Phone:630-437-5175
Mailing Address - Fax:630-437-5174
Practice Address - Street 1:6800 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-3498
Practice Address - Country:US
Practice Address - Phone:630-437-5175
Practice Address - Fax:630-437-5174
Is Sole Proprietor?:No
Enumeration Date:2005-06-12
Last Update Date:2012-09-14
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
IL070010481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202979Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
ILP42872Medicare UPIN