Provider Demographics
NPI:1932645066
Name:THIAGARAJAN, SAKTHIPRABHA
Entity Type:Individual
Prefix:MRS
First Name:SAKTHIPRABHA
Middle Name:
Last Name:THIAGARAJAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 APPLE BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7796
Mailing Address - Country:US
Mailing Address - Phone:404-395-5743
Mailing Address - Fax:
Practice Address - Street 1:2576 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7290
Practice Address - Country:US
Practice Address - Phone:770-962-4043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist