Provider Demographics
NPI:1871969410
Name:MULIK, SUPRIYA S
Entity type:Individual
Prefix:
First Name:SUPRIYA
Middle Name:S
Last Name:MULIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1865
Mailing Address - Country:US
Mailing Address - Phone:573-201-6297
Mailing Address - Fax:
Practice Address - Street 1:3000 BALFOUR CIR
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2144
Practice Address - Country:US
Practice Address - Phone:484-920-6137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist