Provider Demographics
NPI:1487268249
Name:MANKAR, POONAM VASANT (PT)
Entity type:Individual
Prefix:
First Name:POONAM
Middle Name:VASANT
Last Name:MANKAR
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 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5335 W SUBLETT RD STE 151
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1185
Practice Address - Country:US
Practice Address - Phone:817-839-9150
Practice Address - Fax:817-391-8025
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT5755225100000X
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1329460OtherPHYSICAL THERAPY LICENSE
NMPT5755OtherPHYSICAL THERAPIST STATE LICENSE