Provider Demographics
NPI:1114707106
Name:BALAKRISHNAN, SURESHKUMAR (PT)
Entity Type:Individual
Prefix:
First Name:SURESHKUMAR
Middle Name:
Last Name:BALAKRISHNAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 CENTRAL PARK AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1059
Mailing Address - Country:US
Mailing Address - Phone:914-294-0080
Mailing Address - Fax:
Practice Address - Street 1:1254 CENTRAL PARK AVE STE 3
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1059
Practice Address - Country:US
Practice Address - Phone:914-294-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty