Provider Demographics
NPI:1417293630
Name:PAI, SUYASHA AKHIL (RPT)
Entity Type:Individual
Prefix:
First Name:SUYASHA
Middle Name:AKHIL
Last Name:PAI
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8071 RADCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-8060
Mailing Address - Country:US
Mailing Address - Phone:719-351-9210
Mailing Address - Fax:
Practice Address - Street 1:8071 RADCLIFF DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-8060
Practice Address - Country:US
Practice Address - Phone:719-351-9210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-15
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015104225100000X
COPTL.0012424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501015104OtherSTATE OF MI