Provider Demographics
NPI:1184369852
Name:MALAYIL, ROSETTA
Entity type:Individual
Prefix:
First Name:ROSETTA
Middle Name:
Last Name:MALAYIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSETTA
Other - Middle Name:
Other - Last Name:KOZHIKATTU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3411 NIRMAL CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-5319
Mailing Address - Country:US
Mailing Address - Phone:678-472-2213
Mailing Address - Fax:
Practice Address - Street 1:966A KILLIAN HILL RD SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3102
Practice Address - Country:US
Practice Address - Phone:770-923-4815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist