Individual
JISSA THAYIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2406 BROOKHOLLOW TER, GEORGETOWN, TX 78626-7684
(183) 262-0316
Mailing address
2406 BROOKHOLLOW TER, GEORGETOWN, TX 78626-7684
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
1165213
TX
Other
Enumeration date
08/17/2018
Last updated
08/17/2018
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