MEDICARE: DHARA KAGALWALA PT, MPH, CBIS

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	2251G0304X	Geriatric Physical Therapist	9578	TN

General Provider Information

NPI Number	:	1891659272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DHARA KAGALWALA PT, MPH, CBIS

Provider Business Mailing Address
First Line	:	140 PROVIDENCE TRL
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-6386
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 PROVIDENCE TRL
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-6386
Country	:	US
Telephone Number	:	615-758-1237
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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