Provider Demographics
NPI:1629160734
Name:SUDINI, ANITHA (PT)
Entity Type:Individual
Prefix:
First Name:ANITHA
Middle Name:
Last Name:SUDINI
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 1:2927 ADDISON LN
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5052
Mailing Address - Country:US
Mailing Address - Phone:732-597-3757
Mailing Address - Fax:
Practice Address - Street 1:2927 ADDISON LN
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30005-5052
Practice Address - Country:US
Practice Address - Phone:732-597-3757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012448225100000X
GAPT011791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501012448OtherSTATE LICENCE
GAPT011791OtherSTATE LICENSE