MEDICARE: MRIDULA KAIMAL MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	26439	MD

General Provider Information

NPI Number	:	1639683675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRIDULA KAIMAL MSPT

Provider Business Mailing Address
First Line	:	5345 CORINTH CT
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-8100
Country	:	US
Telephone Number	:	412-726-2064
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 E SWAN CREEK RD
Second Line	:
City	:	FT WASHINGTON
State	:	MD
Zip	:	20744-5250
Country	:	US
Telephone Number	:	301-292-9400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2017
Last Update Date	:	11/29/2017

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Directions to “ MRIDULA KAIMAL MSPT” Practice Location

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