Provider Demographics
NPI:1205536620
Name:YAROSLAV MUKHA
Entity type:Organization
Organization Name:YAROSLAV MUKHA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YAROSLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKHA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, OCS
Authorized Official - Phone:267-255-0684
Mailing Address - Street 1:3456 HEATHER RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-4022
Mailing Address - Country:US
Mailing Address - Phone:267-255-0684
Mailing Address - Fax:
Practice Address - Street 1:3456 HEATHER RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-4022
Practice Address - Country:US
Practice Address - Phone:267-255-0684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty