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Organization
POTENTIAL PHYSICAL THERAPY LLC
Active
Organization
POTENTIAL PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUPRIYA S MULIK (PT)
(610) 249-0001
Entity
Organization
Contact information
Practice address
134 LANCASTER AVE, MALVERN, PA 19355-2123
(610) 249-0001
Mailing address
134 LANCASTER AVE, MALVERN, PA 19355-2123
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT023984
STATE LICENSE
PA
Enumeration date
06/08/2018
Last updated
08/31/2020
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