Basic Information
| Provider Information | |||||||||
| NPI: | 1659871911 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUNDERLIN | ||||||||
| FirstName: | MILLIE | ||||||||
| MiddleName: | ELAINE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PATCHAN | ||||||||
| OtherFirstName: | MILLIE | ||||||||
| OtherMiddleName: | ELAINE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1274 MAYFAIR DR | ||||||||
| Address2: | |||||||||
| City: | SEVEN HILLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441311613 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 10204 GRANGER RD | ||||||||
| Address2: | |||||||||
| City: | GARFIELD HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441253106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165812900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2018 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT017308 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.