Healthcare Provider Details

I. General information

NPI: 1184019481
Provider Name (Legal Business Name): SUPRAJA ANGARU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7246 FOREST HILL AVE
RICHMOND VA
23225-1524
US

IV. Provider business mailing address

7512 ANDER CT
RICHMOND VA
23225-2025
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-7901
  • Fax:
Mailing address:
  • Phone: 804-874-9098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305206690
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number032602
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: