Provider Demographics
NPI:1447623020
Name:THARAKAN, TIBU C
Entity type:Individual
Prefix:MR
First Name:TIBU
Middle Name:C
Last Name:THARAKAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BRUCE LN
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1302
Mailing Address - Country:US
Mailing Address - Phone:914-299-2147
Mailing Address - Fax:
Practice Address - Street 1:16 BRUCE LN
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1302
Practice Address - Country:US
Practice Address - Phone:914-299-2147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist