Provider Demographics
NPI:1902179815
Name:SAHASRABUDHE, MRUNMAYI (PT)
Entity Type:Individual
Prefix:
First Name:MRUNMAYI
Middle Name:
Last Name:SAHASRABUDHE
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 1:13011 SUMMERFIELD SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-7402
Mailing Address - Country:US
Mailing Address - Phone:813-374-2209
Mailing Address - Fax:813-374-2211
Practice Address - Street 1:2202 BODRICK CIR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-1228
Practice Address - Country:US
Practice Address - Phone:813-203-5577
Practice Address - Fax:813-203-5577
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist