Provider Demographics
NPI:1659871911
Name:SUNDERLIN, MILLIE ELAINE (DPT)
Entity Type:Individual
Prefix:
First Name:MILLIE
Middle Name:ELAINE
Last Name:SUNDERLIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MILLIE
Other - Middle Name:ELAINE
Other - Last Name:PATCHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1274 MAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-1613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10204 GRANGER RD
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-3106
Practice Address - Country:US
Practice Address - Phone:216-581-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist