Mamta U Bolade, PT

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2305216674 Issued in VA

Practice address

24790 Meadows Farms CT
South Riding, VA 20152-3000

Phone

(703) 372-4445

Fax

(703) 957-3365

NPI assigned

Nov 27, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Chiron Physical Therapy of VA, LLCGroup PAC ID 3577844281, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Chiron Physical Therapy of VA, LLC

  • Physical Therapist
  • South Riding, VA
  • NPI 1902354814
  Medicare reassignment Care Compare group NPD
• Chiron Diagnostics, LLC

  • Clinical Electrophysiology Physical Therapist
  • South Riding, VA
  • NPI 1720720014
  NPD

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

{
    "created_epoch": "1732665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732665600000",
    "number": "1720804339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25476 HARTLAND ORCHARD TER",
            "city": "SOUTH RIDING",
            "state": "VA",
            "postal_code": "201523268",
            "telephone_number": "202-487-0563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24790 MEADOWS FARMS CT",
            "city": "SOUTH RIDING",
            "state": "VA",
            "postal_code": "201523000",
            "telephone_number": "703-372-4445",
            "fax_number": "703-957-3365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLADE",
        "first_name": "MAMTA",
        "middle_name": "U",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-11-27",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "VA",
            "license": "2305216674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dania Yassin Abutaah
• Aging at Home Solutions LLC
• Brittany Bailey, LCSW
• Mary Elizabeth Barrow, PHARMD
• Blue Skyy LLC
• Sylvia J Briceno, O.D.
• Carl M Steger DDS & Associates, PLLC
• Carl M. Steger, DDS & Associates, PLLC
• Chiron Diagnostics, LLC
• Chiron Physical Therapy LLC

• Physical Therapy Assistant in South Riding, VA
• Providers in South Riding, VA by specialty
• Physical Therapy Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.