Provider Demographics
NPI:1831318781
Name:UTMB
Entity type:Organization
Organization Name:UTMB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICALTHERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:JANAKI
Authorized Official - Middle Name:M
Authorized Official - Last Name:MURUGESAN
Authorized Official - Suffix:III
Authorized Official - Credentials:BPT
Authorized Official - Phone:409-877-3543
Mailing Address - Street 1:515 1ST ST
Mailing Address - Street 2:#330
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-5769
Mailing Address - Country:US
Mailing Address - Phone:409-763-5717
Mailing Address - Fax:409-763-5717
Practice Address - Street 1:515 1ST ST
Practice Address - Street 2:#330
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-5769
Practice Address - Country:US
Practice Address - Phone:409-763-5717
Practice Address - Fax:409-763-5717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1081636284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital