Provider Demographics
NPI:1861419426
Name:ALAKULPPI, MIKA P (PT)
Entity type:Individual
Prefix:
First Name:MIKA
Middle Name:P
Last Name:ALAKULPPI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3527 N VALDOSTA RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-6418
Mailing Address - Country:US
Mailing Address - Phone:229-247-2290
Mailing Address - Fax:229-247-5926
Practice Address - Street 1:3520 NORTHCROSSING CIR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1067
Practice Address - Country:US
Practice Address - Phone:229-242-0008
Practice Address - Fax:229-242-8769
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBCKHMedicare ID - Type UnspecifiedVALDOSTA LOCATION