Provider Demographics
NPI:1225320781
Name:ACHAMMA JOB, SUNITHA
Entity Type:Individual
Prefix:MRS
First Name:SUNITHA
Middle Name:
Last Name:ACHAMMA JOB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3278 CORAL RIDGE DRIVE
Mailing Address - Street 2:3278
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065
Mailing Address - Country:US
Mailing Address - Phone:954-394-4464
Mailing Address - Fax:
Practice Address - Street 1:3201 WEST COMMERCIAL BLVD
Practice Address - Street 2:SUITE 116 MEDPRO HEALTH CARE STAFFING
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309
Practice Address - Country:US
Practice Address - Phone:800-886-8108
Practice Address - Fax:866-422-6431
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014232225100000X
NY032763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist