Provider Demographics
NPI:1043546153
Name:ATTILURU, JITHENDRA KUMAR (PT)
Entity Type:Individual
Prefix:MR
First Name:JITHENDRA
Middle Name:KUMAR
Last Name:ATTILURU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 BLUE POINT RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1839
Mailing Address - Country:US
Mailing Address - Phone:631-320-0141
Mailing Address - Fax:631-670-6475
Practice Address - Street 1:465 BLUE POINT RD
Practice Address - Street 2:SUITE A
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1839
Practice Address - Country:US
Practice Address - Phone:631-320-0141
Practice Address - Fax:631-670-6475
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist