Healthcare Provider Details

I. General information

NPI: 1356522411
Provider Name (Legal Business Name): MAULIKA THAKORE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 11/23/2024
Certification Date: 11/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 WALLACE CT STE C
LAKE MARY FL
32746-2161
US

IV. Provider business mailing address

5205 PIPER LN
SANFORD FL
32771-5465
US

V. Phone/Fax

Practice location:
  • Phone: 407-710-8956
  • Fax: 407-732-6597
Mailing address:
  • Phone: 813-843-2401
  • Fax: 407-732-6597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT30276
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501012430
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: