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1306982053
THEODERICK MITRA
NEW HYDE PARK, NY
NPI
1306982053
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225100000X Physical Therapist
(Licence: NY 018279)
Enumeration Date
2007-01-29
Last Update Date
2007-07-08
Business Address
-- THEODERICK MITRA P.T.
111 S 8TH ST
NEW HYDE PARK, NY 11040-4852
Phone number: 516-233-1846
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Mailing Address
-- THEODERICK MITRA P.T.
111 S 8TH ST
NEW HYDE PARK, NY 11040-4852
Phone number: 516-233-1846
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