Provider Demographics
NPI:1508041153
Name:VARANASI, SUNITA (RPT)
Entity Type:Individual
Prefix:MISS
First Name:SUNITA
Middle Name:
Last Name:VARANASI
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MISS
Other - First Name:SUNITA
Other - Middle Name:
Other - Last Name:KAVIKONDALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:29512 7 MILE RD # A
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1988
Mailing Address - Country:US
Mailing Address - Phone:248-427-0340
Mailing Address - Fax:248-427-9528
Practice Address - Street 1:29512 7 MILE RD # A
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1988
Practice Address - Country:US
Practice Address - Phone:248-427-0340
Practice Address - Fax:248-427-9528
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist