MEDICARE: MR. JITHENDRA KUMAR ATTILURU P.T

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	031991	NY

General Provider Information

NPI Number	:	1043546153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JITHENDRA KUMAR ATTILURU P.T

Provider Business Mailing Address
First Line	:	465 BLUE POINT RD
Second Line	:	SUITE A
City	:	FARMINGVILLE
State	:	NY
Zip	:	11738-1839
Country	:	US
Telephone Number	:	631-320-0141
Fax Number	:	631-670-6475

Provider Business Practice Location Address
First Line	:	465 BLUE POINT RD
Second Line	:	SUITE A
City	:	FARMINGVILLE
State	:	NY
Zip	:	11738-1839
Country	:	US
Telephone Number	:	631-320-0141
Fax Number	:	631-670-6475

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2009
Last Update Date	:	10/23/2009

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