Individual provider Active NPI

Mrudula Dora Lingala, PT

  • Physical Therapist
  • Richmond, IN
National Provider Identifier
1023318854
Registry record updated Oct 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
032727 Issued in NY
Practice address
1326 S 18TH St
Apt 49
Richmond, IN 47374-8140
Phone
(603) 479-8384
NPI assigned
Oct 27, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 27, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 032727 NY Primary

Addresses

Primary practice location

1326 S 18TH St
Apt 49
Richmond, IN 47374-8140

Mailing address

1326 S 18TH St
Apt 49
Richmond, IN 47374-8140
Phone (603) 479-8384

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230418002051 IN Practitioner - Physical Therapist in Private Practice 4082089305 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
032727NYMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Aegis Group Practice LLC Physical Therapist CurrentSince Mar 10, 2023 Accepting new patients
Aegis Group Practice LLC Physical Therapist CurrentSince Mar 10, 2023 Accepting new patients
Aegis Group Practice LLC Physical Therapist Current Accepting new patients

Locations

4933 Old Greenwood Rd
Fort Smith, AR 72903

98 N 10th St
Greencastle, IN 46135
Phone (765) 301-4642

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288137600000",
    "number": "1023318854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1326 S 18TH ST",
            "address_2": "APT 49",
            "city": "RICHMOND",
            "state": "IN",
            "postal_code": "473748140",
            "telephone_number": "603-479-8384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1326 S 18TH ST",
            "address_2": "APT 49",
            "city": "RICHMOND",
            "state": "IN",
            "postal_code": "473748140",
            "telephone_number": "603-479-8384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LINGALA",
        "first_name": "MRUDULA",
        "middle_name": "DORA",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-27",
        "last_updated": "2010-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "032727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.