Provider Demographics
NPI:1851449474
Name:CHATANI, SUMI (DPT)
Entity Type:Individual
Prefix:
First Name:SUMI
Middle Name:
Last Name:CHATANI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 BAILIFF CT NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2666
Mailing Address - Country:US
Mailing Address - Phone:770-773-0263
Mailing Address - Fax:
Practice Address - Street 1:11660 ALPHARETTA HWY
Practice Address - Street 2:SUITE 320
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4943
Practice Address - Country:US
Practice Address - Phone:770-754-0085
Practice Address - Fax:770-754-9715
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA141391778AMedicaid