Provider Demographics
NPI:1417248485
Name:KUMAR, THIYAGARAJAN (PT)
Entity Type:Individual
Prefix:MR
First Name:THIYAGARAJAN
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:THIYAGARAJAN
Other - Middle Name:
Other - Last Name:K
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3201 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3440
Mailing Address - Country:US
Mailing Address - Phone:954-200-2126
Mailing Address - Fax:
Practice Address - Street 1:3201 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3440
Practice Address - Country:US
Practice Address - Phone:954-200-2126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015141225100000X
NY033476225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist