Individual
MARIAH IDUL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
501 DISCOVERY DR, CHESAPEAKE, VA 23320-3832
(757) 547-5145
Mailing address
4084 CONCORDIA WAY, VIRGINIA BEACH, VA 23453-1760
(757) 636-5849
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305214983
VA
Other
Enumeration date
06/14/2022
Last updated
06/14/2022
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