Provider Demographics
NPI:1770623951
Name:TAMAKUWALA, MARISHA DHIREN (RPT)
Entity type:Individual
Prefix:MISS
First Name:MARISHA
Middle Name:DHIREN
Last Name:TAMAKUWALA
Suffix:
Gender:F
Credentials:RPT
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Mailing Address - Street 1:680 MIX AVE
Mailing Address - Street 2:APARTMENT 5J
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2383
Mailing Address - Country:US
Mailing Address - Phone:203-535-7650
Mailing Address - Fax:203-729-2355
Practice Address - Street 1:1183 NEW HAVEN RD
Practice Address - Street 2:HILLSMAN SUITE
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-5033
Practice Address - Country:US
Practice Address - Phone:203-729-2344
Practice Address - Fax:203-729-2355
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT008048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008048OtherLICENSE