Provider Demographics
NPI:1801829817
Name:NADUPARAMBIL, SANJAIMON II
Entity Type:Individual
Prefix:
First Name:SANJAIMON
Middle Name:
Last Name:NADUPARAMBIL
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4022 TURQUOISE TRL
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3182
Mailing Address - Country:US
Mailing Address - Phone:954-274-0415
Mailing Address - Fax:954-302-2893
Practice Address - Street 1:4022 TURQUOISE TRL
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3182
Practice Address - Country:US
Practice Address - Phone:954-274-0415
Practice Address - Fax:954-302-2893
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 19750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0594ZMedicare ID - Type UnspecifiedPROVIDER NUMBER