Provider Demographics
NPI:1306412093
Name:SUNDARAM, MEERA E (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MEERA
Middle Name:E
Last Name:SUNDARAM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 ELMIRA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5115
Mailing Address - Country:US
Mailing Address - Phone:607-272-9937
Mailing Address - Fax:888-978-4495
Practice Address - Street 1:376 ELMIRA RD STE 100
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5115
Practice Address - Country:US
Practice Address - Phone:607-272-9937
Practice Address - Fax:888-978-4495
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046633-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist