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NPI Code Detail

MEDICARE: SUPRIYA PRADHAN PT

MEDICARE: SUPRIYA PRADHAN 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
1225100000XPhysical Therapist1205875TX

General Provider Information

NPI Number : 1528435765
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUPRIYA PRADHAN PT
Provider Business Mailing Address
First Line : 9801 S 1ST ST
Second Line :
City : AUSTIN
State : TX
Zip : 78748-6760
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9801 S 1ST ST
Second Line :
City : AUSTIN
State : TX
Zip : 78748-6760
Country : US
Telephone Number : 512-292-3071
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2015
Last Update Date : 04/02/2016

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Directions to “ SUPRIYA PRADHAN PT” Practice Location

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