Provider Demographics
NPI:1497413280
Name:PREMIER HAND THERAPY LLC
Entity Type:Organization
Organization Name:PREMIER HAND THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANGEETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BULUSU
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:941-914-5983
Mailing Address - Street 1:1775 ARLINGTON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2143
Mailing Address - Country:US
Mailing Address - Phone:941-914-5983
Mailing Address - Fax:
Practice Address - Street 1:1775 ARLINGTON ST STE 2
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2143
Practice Address - Country:US
Practice Address - Phone:941-914-5983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT15341OtherMEDICAL LICENSE