Doctor Name: | SUSAN VARGHESE MAMMEN |
NPI Number: | 1164752564 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 62-027654 |
Business Practice Address: | 22 Odyssey #165 Irvine, CA - 926183186 |
Business Phone Number: | 9497272192 |
Business Fax Number: | |
Mailing Address: | 22 Odyssey, #165 IRVINE |
State: | CA |
Postal Code: | 926183186 |
Phone Number: | 9497272192 |
Fax Number: | |
NPI Enumeration Date: | 01/06/2010 |
NPI Last Update Date: | 05/19/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 62-027654 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NY |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |