Individual
MITAL TAMAKUWALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
2827 W PEORIA AVE STE B112, PHOENIX, AZ 85029-5217
(602) 610-8665
(623) 322-0664
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501015287
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5501015287
STATE OF MICHIGAN
MI
Enumeration date
10/18/2011
Last updated
07/19/2024
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