Provider Demographics
NPI:1871924985
Name:MALIWAD, POOLATSYA GIRISHBHAI (PT)
Entity type:Individual
Prefix:MR
First Name:POOLATSYA
Middle Name:GIRISHBHAI
Last Name:MALIWAD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 HONEYWOOD LN
Mailing Address - Street 2:APT-G
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-8871
Mailing Address - Country:US
Mailing Address - Phone:551-580-5281
Mailing Address - Fax:
Practice Address - Street 1:22960 SHAW RD
Practice Address - Street 2:SUITE 605
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-9447
Practice Address - Country:US
Practice Address - Phone:410-750-9006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-29
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist