Basic Information
| Provider Information | |||||||||
| NPI: | 1972083707 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUDANAGUNTA | ||||||||
| FirstName: | SWARNA | ||||||||
| MiddleName: | LATHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 S AUSTIN ST STE B | ||||||||
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| City: | COMANCHE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764423261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027476780 | ||||||||
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| Practice Location | |||||||||
| Address1: | 809 E NAVARRO AVE | ||||||||
| Address2: | |||||||||
| City: | DE LEON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764441275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2548932075 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2018 | ||||||||
| LastUpdateDate: | 08/21/2018 | ||||||||
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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 | 225200000X | 2125970 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.