Provider Demographics
NPI:1831561349
Name:KAREESAN, KUMARAGURU (PT, MHS)
Entity type:Individual
Prefix:
First Name:KUMARAGURU
Middle Name:
Last Name:KAREESAN
Suffix:
Gender:M
Credentials:PT, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2167 ERIKA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-8138
Mailing Address - Country:US
Mailing Address - Phone:707-694-2398
Mailing Address - Fax:
Practice Address - Street 1:3857 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-5244
Practice Address - Country:US
Practice Address - Phone:707-694-2398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist