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General NPI Number Information
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NPI Number | 1538472436
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Entity Type | Individual
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Provider Name | MALIKAH MARYAM MUSTAFA PT, DPT, MTC
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Gender | Female
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Dates
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Enumeration Date | 07/20/2010
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Last Update Date | 06/14/2019
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Provider Practice Location Address
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Address Line | 200 WELLMORE DR
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City | LEXINGTON
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State | SC
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Zip | 29072-9172
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Country | US
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Telephone | 803-520-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 1533 WALNUT VIEW DR
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City | CHARLOTTE
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State | NC
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Zip | 28208-4672
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Country | US
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Telephone | 919-906-1262
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 25689
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9603
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License Number State | SC
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