Provider Demographics
NPI:1649583915
Name:SURAPARAJU, SUSHITHA (MPT)
Entity Type:Individual
Prefix:MRS
First Name:SUSHITHA
Middle Name:
Last Name:SURAPARAJU
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N KENILWORTH AVE
Mailing Address - Street 2:APT 6D
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301
Mailing Address - Country:US
Mailing Address - Phone:909-499-9515
Mailing Address - Fax:
Practice Address - Street 1:1401 NORTH CALIFORNIA AVE
Practice Address - Street 2:GENESIS REHAB
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:773-276-5767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017525225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist