Provider Demographics
NPI:1578238226
Name:NITHIANANDA, SHANTHA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SHANTHA
Middle Name:
Last Name:NITHIANANDA
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 1:933 WOOD HOLLOW DR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8442
Mailing Address - Country:US
Mailing Address - Phone:214-500-9432
Mailing Address - Fax:
Practice Address - Street 1:4920 ROSWELL RD STE 36
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2636
Practice Address - Country:US
Practice Address - Phone:214-500-9432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-14
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0140662251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology