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General NPI Number Information
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NPI Number | 1831487388
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Entity Type | Individual
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Provider Name | MRIDULA CHANDHOKE
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Gender | Female
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 1973 N. TRACY BLVD
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City | TRACY
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State | CA
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Zip | 95376-2459
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Country | US
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Telephone | 209-833-9490
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX1155
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City | TRACY
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State | CA
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Zip | 95378-1155
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Country | US
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Telephone |
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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 | 28784
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License Number State | CA
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