Provider Demographics
NPI:1942981717
Name:JARUGULA, SUJATA Y
Entity Type:Individual
Prefix:
First Name:SUJATA
Middle Name:Y
Last Name:JARUGULA
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 1:4235 COLD SPRING CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5865
Mailing Address - Country:US
Mailing Address - Phone:319-774-9411
Mailing Address - Fax:
Practice Address - Street 1:5722 CLARION ST
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-0306
Practice Address - Country:US
Practice Address - Phone:319-774-9411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100072225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist