Provider Demographics
NPI:1447668561
Name:AVADHANAM, AVANTHI
Entity type:Individual
Prefix:
First Name:AVANTHI
Middle Name:
Last Name:AVADHANAM
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 1:11 HAWTHORN DR
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-1932
Mailing Address - Country:US
Mailing Address - Phone:609-955-2240
Mailing Address - Fax:
Practice Address - Street 1:2277 NJ 33
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690
Practice Address - Country:US
Practice Address - Phone:609-838-7284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034105225100000X
NJ40QA01469200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist