Provider Demographics
NPI:1659633105
Name:MENON, NANDAKUMAR (PT)
Entity Type:Individual
Prefix:MR
First Name:NANDAKUMAR
Middle Name:
Last Name:MENON
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 1:26 MAIN ST
Mailing Address - Street 2:UNIT 1, 2ND FLOOR
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2536
Mailing Address - Country:US
Mailing Address - Phone:339-203-3893
Mailing Address - Fax:
Practice Address - Street 1:26 MAIN ST
Practice Address - Street 2:UNIT 1, 2ND FLOOR
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2536
Practice Address - Country:US
Practice Address - Phone:339-203-3893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19040225100000X, 2251G0304X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic