Provider Demographics
NPI:1336756774
Name:MITU, DARLA LOUISE DORADO
Entity Type:Individual
Prefix:MISS
First Name:DARLA LOUISE
Middle Name:DORADO
Last Name:MITU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 LEBANON RD APT 725
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8275
Mailing Address - Country:US
Mailing Address - Phone:718-415-6665
Mailing Address - Fax:
Practice Address - Street 1:11700 LEBANON RD APT 725
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-8275
Practice Address - Country:US
Practice Address - Phone:718-415-6665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist