Active NPI
Michael Perumattathil
- Physical Therapist
- Clarksville, MD
National Provider Identifier
1093604035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 30450
- Practice address
- 12143 Clarksville Pike Ste 101
Clarksville, MD 21029-1565 - Phone
- (443) 230-5339
- NPI assigned
- Jul 2, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 30450 | MD | Primary |
Addresses
Primary practice location
12143 Clarksville Pike Ste 101
Clarksville, MD 21029-1565
Mailing address
2788 Cheekwood Cir
Ellicott City, MD 21042-2472
Phone (443) 942-7070
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30450 | MD | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1751414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751414400000",
"number": "1093604035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2788 CHEEKWOOD CIR",
"city": "ELLICOTT CITY",
"state": "MD",
"postal_code": "210422472",
"telephone_number": "443-942-7070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12143 CLARKSVILLE PIKE STE 101",
"city": "CLARKSVILLE",
"state": "MD",
"postal_code": "210291565",
"telephone_number": "443-230-5339"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERUMATTATHIL",
"first_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-07-02",
"last_updated": "2025-07-02",
"certification_date": "2025-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "30450",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.