Provider Demographics
NPI:1891984746
Name:JOSE, THAMPI KODENKANDATH (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:THAMPI
Middle Name:KODENKANDATH
Last Name:JOSE
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8036 NIELSEN DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2689
Mailing Address - Country:US
Mailing Address - Phone:810-824-7246
Mailing Address - Fax:
Practice Address - Street 1:8036 NIELSEN DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2689
Practice Address - Country:US
Practice Address - Phone:810-824-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0500944A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist