Provider Demographics
NPI:1437108636
Name:DURAIPANDIAN, GAYATHRI (PT)
Entity Type:Individual
Prefix:
First Name:GAYATHRI
Middle Name:
Last Name:DURAIPANDIAN
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 1:2695 BONAIRE TER
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4767
Mailing Address - Country:US
Mailing Address - Phone:248-977-0556
Mailing Address - Fax:
Practice Address - Street 1:2695 BONAIRE TER
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-4767
Practice Address - Country:US
Practice Address - Phone:248-977-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012636225100000X
GAPT011786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN93670018Medicare PIN