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General NPI Number Information
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NPI Number | 1962717868
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Entity Type | Organization
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Legal Business Name | MAYA PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 02/08/2013
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Provider Practice Location Address
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Address Line | 5745 S UNIVERSITY DR
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City | DAVIE
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State | FL
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Zip | 33328-6114
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Country | US
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Telephone | 954-252-9619
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Fax | 954-252-9620
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Provider Business Mailing Address
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Address Line | 4022 TURQUOISE TRL
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City | WESTON
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State | FL
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Zip | 33331-3182
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Country | US
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Telephone | 954-252-9619
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Fax | 954-252-9620
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANJAIMON K NADUPARAMBIL
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Credential | PT
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Telephone | 954-274-0415
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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 | PT19750
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License Number State | FL
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