Provider Demographics
NPI:1811072754
Name:THYPARAMBIL, NEETHU MATHEW (PT)
Entity type:Individual
Prefix:MRS
First Name:NEETHU
Middle Name:MATHEW
Last Name:THYPARAMBIL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:NEETHU
Other - Middle Name:
Other - Last Name:KATTOTTIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3960 BRAVEHEART CIR
Mailing Address - Street 2:1902
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7743
Mailing Address - Country:US
Mailing Address - Phone:501-231-6159
Mailing Address - Fax:
Practice Address - Street 1:198 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 19
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4398
Practice Address - Country:US
Practice Address - Phone:301-898-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62026735225100000X
PAPT018704225100000X
MD23232225100000X
ARPT 2914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161715721Medicaid