Individual
MRS. MAMTA U BOLADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
24790 MEADOWS FARMS CT, SOUTH RIDING, VA 20152-3000
(703) 372-4445
(703) 957-3365
Mailing address
25476 HARTLAND ORCHARD TER, SOUTH RIDING, VA 20152-3268
(202) 487-0563
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2305216674
VA
Other
Enumeration date
11/27/2024
Last updated
11/27/2024
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