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General NPI Number Information
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NPI Number | 1649583915
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Entity Type | Individual
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Provider Name | SUSHITHA SURAPARAJU M.P.T
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Gender | Female
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 1401 NORTH CALIFORNIA AVE GENESIS REHAB
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City | CHICAGO
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State | IL
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Zip | 60622
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Country | US
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Telephone | 773-276-5767
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Fax |
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Provider Business Mailing Address
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Address Line | 110 N KENILWORTH AVE APT 6D
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City | OAK PARK
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State | IL
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Zip | 60301
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Country | US
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Telephone | 909-499-9515
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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 | 070.017525
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License Number State | IL
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