Provider Demographics
NPI:1710496039
Name:MERCHANT, SUCHEETA SHANTIKUMAR (PT)
Entity Type:Individual
Prefix:
First Name:SUCHEETA
Middle Name:SHANTIKUMAR
Last Name:MERCHANT
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 1:7555 HOMEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3666
Mailing Address - Country:US
Mailing Address - Phone:925-918-3363
Mailing Address - Fax:925-918-3363
Practice Address - Street 1:7555 HOMEWOOD CT
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3666
Practice Address - Country:US
Practice Address - Phone:925-918-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist