Provider Demographics
NPI:1376965939
Name:PILLAI, MRUDULA MADHAV (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MRUDULA
Middle Name:MADHAV
Last Name:PILLAI
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MERRIMAC ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1126
Mailing Address - Country:US
Mailing Address - Phone:716-319-0654
Mailing Address - Fax:
Practice Address - Street 1:124 MERRIMAC ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1126
Practice Address - Country:US
Practice Address - Phone:716-319-0654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist