Individual
MIRA RIAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
171 WESTERVELT PL, LODI, NJ 07644-1105
(201) 932-6464
Mailing address
171 WESTERVELT PL, LODI, NJ 07644-1105
(201) 932-6464
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
010317
NY
Other
Enumeration date
12/22/2016
Last updated
12/22/2016
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