Provider Demographics
NPI:1467933010
Name:SAMKUTTY, JOMY JOY (PT, MHA)
Entity Type:Individual
Prefix:
First Name:JOMY
Middle Name:JOY
Last Name:SAMKUTTY
Suffix:
Gender:F
Credentials:PT, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 LIBERTY PARK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6891
Mailing Address - Country:US
Mailing Address - Phone:240-678-5049
Mailing Address - Fax:
Practice Address - Street 1:1034 LIBERTY PARK DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6891
Practice Address - Country:US
Practice Address - Phone:512-328-3775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012262225100000X
TX1299080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist