Provider Demographics
NPI:1114294121
Name:SAUHTA, FORUM (PT)
Entity Type:Individual
Prefix:
First Name:FORUM
Middle Name:
Last Name:SAUHTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11311 JAMAICA AVE
Mailing Address - Street 2:ISLAND MUSCULOSKELETAL CARE
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2476
Mailing Address - Country:US
Mailing Address - Phone:718-850-6577
Mailing Address - Fax:718-850-6581
Practice Address - Street 1:11311 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2476
Practice Address - Country:US
Practice Address - Phone:718-850-6577
Practice Address - Fax:718-850-6581
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033785-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist