Provider Demographics
NPI:1558126714
Name:CHAUDHARY, SUSHANKI (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SUSHANKI
Middle Name:
Last Name:CHAUDHARY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 MADISON PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6355
Mailing Address - Country:US
Mailing Address - Phone:443-583-3757
Mailing Address - Fax:
Practice Address - Street 1:1413 MADISON PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6355
Practice Address - Country:US
Practice Address - Phone:443-583-3757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist