Provider Demographics
NPI:1821297342
Name:VIRKUD, MADHUKAR MAHADEO (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:MADHUKAR
Middle Name:MAHADEO
Last Name:VIRKUD
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-7913
Mailing Address - Country:US
Mailing Address - Phone:727-343-4128
Mailing Address - Fax:727-343-4128
Practice Address - Street 1:5701 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7913
Practice Address - Country:US
Practice Address - Phone:727-343-4128
Practice Address - Fax:727-343-4128
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 5151225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist