Healthcare Provider Details

I. General information

NPI: 1821700105
Provider Name (Legal Business Name): JAYARAM PARAKKATTU PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COULTER RD
CLIFTON SPRINGS NY
14432-1122
US

IV. Provider business mailing address

1715 MAPLE RDG APT 1
HASLETT MI
48840-8645
US

V. Phone/Fax

Practice location:
  • Phone: 315-462-9561
  • Fax:
Mailing address:
  • Phone: 517-402-5593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number049525
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: