Miji P Maliekkal, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070017789 Issued in IL

Practice address

236 Biscayne St
Bloomingdale, IL 60108-3311

Phone

(708) 715-7510

NPI assigned

Mar 3, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646265600000",
    "number": "1639826225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "236 BISCAYNE ST",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601083311",
            "telephone_number": "708-715-7510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "236 BISCAYNE ST",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601083311",
            "telephone_number": "708-715-7510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALIEKKAL",
        "first_name": "MIJI",
        "middle_name": "P",
        "name_prefix": "Mrs.",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-03",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070017789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mahdi Dental LLC
• Mohammed Ahmed Mahdi Sr.
• Gregory Lee Mahoney, M.A., L.C.P.C.
• Mahrukh Subhani Inc
• Gerald Maida, MD
• Phillip Kreg Mallow, DDS
• Donovan Chase Maloney
• Mandeep S Kohli DO SC
• Agnieszka Magdalena Mantzas, LCPC, CEAP
• Anas Maqsood, RPH

• Physical Therapist in Bloomingdale, IL
• Providers in Bloomingdale, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.