Healthcare Provider Details

I. General information

NPI: 1134506397
Provider Name (Legal Business Name): DHRITHI AIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5173 MAIN ST
MOUNT JACKSON VA
22842-9513
US

IV. Provider business mailing address

5173 MAIN ST
MOUNT JACKSON VA
22842-9513
US

V. Phone/Fax

Practice location:
  • Phone: 317-853-0734
  • Fax:
Mailing address:
  • Phone: 540-459-1352
  • Fax: 317-388-0805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1253253
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2305212101
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: