Provider Demographics
NPI:1508366220
Name:PURI, SURBHI
Entity Type:Individual
Prefix:
First Name:SURBHI
Middle Name:
Last Name:PURI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 SW WINDRIFT AVE # 2
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-8475
Mailing Address - Country:US
Mailing Address - Phone:702-613-7677
Mailing Address - Fax:
Practice Address - Street 1:3102 SW WINDRIFT AVE # 2
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-8475
Practice Address - Country:US
Practice Address - Phone:702-613-7677
Practice Address - Fax:702-613-7677
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist