MEDICARE: LIYA OOMMEN

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

General Provider Information

NPI Number	:	1629641774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIYA OOMMEN

Provider Business Mailing Address
First Line	:	6108 S RICE AVE STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-2983
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6108 S RICE AVE STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-2983
Country	:	US
Telephone Number	:	713-660-0663
Fax Number	:

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

Provider Enumeration Date	:	07/16/2021
Last Update Date	:	07/16/2021

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Directions to “ LIYA OOMMEN ” Practice Location

Language	Start Address	Practice Location

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