Provider Demographics
NPI:1336627801
Name:PANICKER, VINEETH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:VINEETH
Middle Name:
Last Name:PANICKER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HARMON DR
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-1811
Mailing Address - Country:US
Mailing Address - Phone:914-426-9798
Mailing Address - Fax:
Practice Address - Street 1:55 HARMON DR
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-1811
Practice Address - Country:US
Practice Address - Phone:914-426-9798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MEPT5253225100000X
KY007596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist