Healthcare Provider Details

I. General information

NPI: 1740626704
Provider Name (Legal Business Name): SWATI KUTHIALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 BUNKER HILL RD NE
WASHINGTON DC
20017-3026
US

IV. Provider business mailing address

1420 N ST NW APT 214
WASHINGTON DC
20005-2839
US

V. Phone/Fax

Practice location:
  • Phone: 202-701-0054
  • Fax:
Mailing address:
  • Phone: 202-701-0054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT871075
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: