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General NPI Number Information
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NPI Number | 1538868112
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Entity Type | Individual
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Provider Name | PRAMUK PELIYAGODA DPT
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Gender | Male
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Dates
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Enumeration Date | 03/02/2023
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 401 W HAMPDEN PL
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City | ENGLEWOOD
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State | CO
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Zip | 80110-2470
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Country | US
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Telephone | 303-781-7511
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Fax |
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Provider Business Mailing Address
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Address Line | 6336 GLADIOLA CIR
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City | CHINO HILLS
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State | CA
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Zip | 91709-4522
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Country | US
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Telephone | 949-793-5141
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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 | PTL26645
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License Number State | MA
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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 | PTL.0020228
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License Number State | CO
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