Provider Demographics
NPI:1376005876
Name:VIROJA, MADHVI (PTA)
Entity Type:Individual
Prefix:
First Name:MADHVI
Middle Name:
Last Name:VIROJA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MISSIONARY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2143
Mailing Address - Country:US
Mailing Address - Phone:860-754-3033
Mailing Address - Fax:860-635-1497
Practice Address - Street 1:52 MISSIONARY RD STE 1
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2143
Practice Address - Country:US
Practice Address - Phone:860-754-3033
Practice Address - Fax:860-635-1497
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001959225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001959OtherDPH