Healthcare Provider Details

I. General information

NPI: 1992878557
Provider Name (Legal Business Name): PRIYA KARAKKATTIL P.T.MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 SPRING VALLEY RD SUITE 40
DALLAS TX
75244-3956
US

IV. Provider business mailing address

4801 SPRING VALLEY RD SUITE 40
DALLAS TX
75244-3956
US

V. Phone/Fax

Practice location:
  • Phone: 972-488-9686
  • Fax: 972-241-1936
Mailing address:
  • Phone: 972-488-9686
  • Fax: 972-241-1936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1126068
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: