Provider Demographics
NPI:1457424509
Name:GUNASEKARAN, UMARANI MURUGESAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:UMARANI
Middle Name:MURUGESAN
Last Name:GUNASEKARAN
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 1:815 STEWART RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-9609
Mailing Address - Country:US
Mailing Address - Phone:765-641-7905
Mailing Address - Fax:765-641-9858
Practice Address - Street 1:815 STEWART RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-9609
Practice Address - Country:US
Practice Address - Phone:765-641-7905
Practice Address - Fax:765-641-9858
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003521A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200721500AMedicaid