Provider Demographics
NPI:1124620737
Name:THAIMURIYIL, NITHIN THOMAS (PT, DPT)
Entity type:Individual
Prefix:
First Name:NITHIN
Middle Name:THOMAS
Last Name:THAIMURIYIL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 GUADALUPE DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3336
Mailing Address - Country:US
Mailing Address - Phone:469-682-2465
Mailing Address - Fax:
Practice Address - Street 1:510 N COIT RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5446
Practice Address - Country:US
Practice Address - Phone:972-437-2048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1338152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist