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General NPI Number Information
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NPI Number | 1205558293
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Entity Type | Individual
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Provider Name | SUBASH GURUNG PT
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Gender | Male
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Dates
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Enumeration Date | 09/15/2022
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 1505 GRANVILLE RD
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City | NEWARK
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State | OH
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Zip | 43055-1582
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Country | US
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Telephone | 740-321-1021
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Fax | 740-321-1021
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Provider Business Mailing Address
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Address Line | 2122 YORK RD STE 300
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City | OAK BROOK
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State | IL
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Zip | 60523-1925
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Country | US
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Telephone | 630-575-1914
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT020082
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License Number State | OH
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