Provider Demographics
NPI:1598226169
Name:VENKATARAMAN, MUTHURAMAN (PT)
Entity Type:Individual
Prefix:
First Name:MUTHURAMAN
Middle Name:
Last Name:VENKATARAMAN
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 1:5530 WISCONSIN AVE STE 1650
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4323
Mailing Address - Country:US
Mailing Address - Phone:301-657-9876
Mailing Address - Fax:301-657-8229
Practice Address - Street 1:5530 WISCONSIN AVE STE 1650
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4323
Practice Address - Country:US
Practice Address - Phone:301-657-9876
Practice Address - Fax:301-657-8229
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist