Provider Demographics
NPI:1649593435
Name:MUJUMDAR, MEENAL A (PT)
Entity Type:Individual
Prefix:
First Name:MEENAL
Middle Name:A
Last Name:MUJUMDAR
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 1:175 E EL CAMINO REAL STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2700
Mailing Address - Country:US
Mailing Address - Phone:650-603-0998
Mailing Address - Fax:
Practice Address - Street 1:175 E EL CAMINO REAL STE B
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2700
Practice Address - Country:US
Practice Address - Phone:650-603-0998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 36561225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA095YMedicare PIN