Provider Demographics
NPI:1174178495
Name:MALLIKA ARACHCHIGE DONA, WASANA UDAYANGANI (PT)
Entity Type:Individual
Prefix:
First Name:WASANA
Middle Name:UDAYANGANI
Last Name:MALLIKA ARACHCHIGE DONA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PINTO POINT PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77389-4390
Mailing Address - Country:US
Mailing Address - Phone:713-726-6577
Mailing Address - Fax:
Practice Address - Street 1:11830 NORTHPOINTE BLVD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-5536
Practice Address - Country:US
Practice Address - Phone:281-205-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-04
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040757225100000X
MO2017038182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist