MEDICARE: SHARADA SRIPATHI PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT009355	GA

General Provider Information

NPI Number	:	1659519007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARADA SRIPATHI PT

Provider Business Mailing Address
First Line	:	960 E PACES FERRY RD NE APT 441
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-2854
Country	:	US
Telephone Number	:	770-337-8496
Fax Number	:

Provider Business Practice Location Address
First Line	:	960 E PACES FERRY RD NE APT 441
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-2854
Country	:	US
Telephone Number	:	770-337-8496
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2009
Last Update Date	:	03/12/2009

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