Basic Information
| Provider Information | |||||||||
| NPI: | 1225320781 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ACHAMMA JOB | ||||||||
| FirstName: | SUNITHA | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3278 CORAL RIDGE DRIVE | ||||||||
| Address2: | 3278 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543944464 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3201 WEST COMMERCIAL BLVD | ||||||||
| Address2: | SUITE 116 MEDPRO HEALTH CARE STAFFING | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008868108 | ||||||||
| FaxNumber: | 8664226431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2011 | ||||||||
| LastUpdateDate: | 05/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501014232 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 032763 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.