Healthcare Provider Details

I. General information

NPI: 1164529715
Provider Name (Legal Business Name): SIVAPRASAD PARNAM PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 SOLDIERS HOME RD
WEST LAFAYETTE BRA IN
47906-1222
US

IV. Provider business mailing address

2601 SOLDIERS HOME RD
WEST LAFAYETTE BRA IN
47906-1653
US

V. Phone/Fax

Practice location:
  • Phone: 765-463-1541
  • Fax:
Mailing address:
  • Phone: 203-517-5022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number028303
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number05009075A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: