Provider Demographics
NPI:1255492823
Name:SUNDH, LAILA O (PT)
Entity Type:Individual
Prefix:
First Name:LAILA
Middle Name:O
Last Name:SUNDH
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 1:2670 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3814
Mailing Address - Country:US
Mailing Address - Phone:517-336-0547
Mailing Address - Fax:517-336-7036
Practice Address - Street 1:2670 LINDEN ST
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3814
Practice Address - Country:US
Practice Address - Phone:517-336-0547
Practice Address - Fax:517-336-7036
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI65-0-C3-1261-0OtherBLUE CROSS BLUE SHIELD
MI65-0-C3-1261-0OtherBLUE CROSS BLUE SHIELD