Provider Demographics
NPI:1659979235
Name:SAMU, SUDHA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:SUDHA
Middle Name:
Last Name:SAMU
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1270
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36251-1270
Mailing Address - Country:US
Mailing Address - Phone:256-354-1195
Mailing Address - Fax:256-354-1294
Practice Address - Street 1:83825 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:AL
Practice Address - Zip Code:36251-7981
Practice Address - Country:US
Practice Address - Phone:256-354-1195
Practice Address - Fax:256-354-1294
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15326225100000X
ALPTH7403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist