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General NPI Number Information
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NPI Number | 1396167995
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Entity Type | Individual
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Provider Name | JACOB KURUVILLA PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 01/16/2014
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Last Update Date | 01/16/2014
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Provider Practice Location Address
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Address Line | 7305 N MILITARY TRL
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City | RIVIERA BEACH
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State | FL
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Zip | 33410-7417
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Country | US
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Telephone | 561-422-7746
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Fax |
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Provider Business Mailing Address
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Address Line | 3500 BRIAR BAY BLVD APT # 105
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-7408
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Country | US
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Telephone | 586-738-7217
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501013119
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License Number State | MI
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