Provider Demographics
NPI:1083002554
Name:BALARAMAN, RUPA (MPT)
Entity Type:Individual
Prefix:
First Name:RUPA
Middle Name:
Last Name:BALARAMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 LOGANS WAY
Mailing Address - Street 2:UNIT 2
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7514
Mailing Address - Country:US
Mailing Address - Phone:443-204-4825
Mailing Address - Fax:
Practice Address - Street 1:4 ETHEL RD
Practice Address - Street 2:SUITE 403B
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817
Practice Address - Country:US
Practice Address - Phone:732-429-1955
Practice Address - Fax:732-549-5549
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT871518225100000X
MDMD25363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPT871518OtherPT LICENSE