Provider Demographics
NPI:1164561122
Name:PUTHIYAMADAM, ROSEANN J (PT, MSED ,PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSEANN
Middle Name:J
Last Name:PUTHIYAMADAM
Suffix:
Gender:F
Credentials:PT, MSED ,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 DONALD DR
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-3623
Mailing Address - Country:US
Mailing Address - Phone:914-310-7263
Mailing Address - Fax:
Practice Address - Street 1:440 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-2418
Practice Address - Country:US
Practice Address - Phone:914-777-3654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17712225100000X
NY0293892251P0200X
NY023989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics