Provider Demographics
NPI:1932540523
Name:PUTHANPURAYIL, SREEJITH (PT)
Entity Type:Individual
Prefix:
First Name:SREEJITH
Middle Name:
Last Name:PUTHANPURAYIL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 FOREST PARK CT
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2552
Mailing Address - Country:US
Mailing Address - Phone:817-851-8727
Mailing Address - Fax:
Practice Address - Street 1:921 FOREST PARK CT
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2552
Practice Address - Country:US
Practice Address - Phone:817-851-8727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1192290225100000X
NY030126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist