Provider Demographics
NPI:1598804247
Name:SURDI, HARRIET INA (PT)
Entity Type:Individual
Prefix:MRS
First Name:HARRIET
Middle Name:INA
Last Name:SURDI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:3911 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2147
Practice Address - Country:US
Practice Address - Phone:919-258-2714
Practice Address - Fax:410-648-4878
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00613700225100000X
NY006003225100000X
DEJ1-0004060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ54381Medicare PIN
NJ121509YAGIMedicare UPIN