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NPI Code Detail

MEDICARE: MUDRIKA TAILOR PT

MEDICARE: MUDRIKA TAILOR PT
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
1225100000XPhysical Therapist2305210068VA

General Provider Information

NPI Number : 1922327840
Entity Type Code : Individual
Provider Name (Legal Business Name) : MUDRIKA TAILOR PT
Provider Business Mailing Address
First Line : 350 NEW FIDELITY CT
Second Line :
City : GARNER
State : NC
Zip : 27529-2665
Country : US
Telephone Number : 919-258-2714
Fax Number : 410-648-4878
Provider Business Practice Location Address
First Line : 4613 DUKE ST STE B
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22304-2559
Country : US
Telephone Number : 703-751-1052
Fax Number : 703-751-1053
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2010
Last Update Date : 12/17/2021

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Directions to “ MUDRIKA TAILOR PT” Practice Location

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