MEDICARE: ALISHA NIZAR MUKADAM PT, DPT, RD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1370749	TX

General Provider Information

NPI Number	:	1750090577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISHA NIZAR MUKADAM PT, DPT, RD, LD

Provider Business Mailing Address
First Line	:	5927 ALMEDA RD UNIT 22310
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-8074
Country	:	US
Telephone Number	:	327-681-8218
Fax Number	:

Provider Business Practice Location Address
First Line	:	25140 KINGSLAND BLVD STE 203
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-8472
Country	:	US
Telephone Number	:	832-768-1821
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2022
Last Update Date	:	02/14/2025

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