Provider Demographics
NPI:1871701052
Name:ABRAHAM, JIJU MYLACKAL (MPT)
Entity type:Individual
Prefix:MR
First Name:JIJU
Middle Name:MYLACKAL
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 WATERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1725
Mailing Address - Country:US
Mailing Address - Phone:713-443-4681
Mailing Address - Fax:
Practice Address - Street 1:2939 WOODLAND PARK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2687
Practice Address - Country:US
Practice Address - Phone:281-870-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist