Provider Demographics
NPI:1649302670
Name:MUTHURAJU, SOMASUNDARAM (PT)
Entity type:Individual
Prefix:MR
First Name:SOMASUNDARAM
Middle Name:
Last Name:MUTHURAJU
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 1:7830 INDIAN BLANKET
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-8563
Mailing Address - Country:US
Mailing Address - Phone:409-860-4501
Mailing Address - Fax:409-860-4501
Practice Address - Street 1:7830 INDIAN BLANKET
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77713-8563
Practice Address - Country:US
Practice Address - Phone:409-860-4501
Practice Address - Fax:409-860-4501
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1081651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist