Provider Demographics
NPI:1457690562
Name:THIRUGNANA, SIVAKUMAR (DPT)
Entity Type:Individual
Prefix:
First Name:SIVAKUMAR
Middle Name:
Last Name:THIRUGNANA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:SIVAKUMAR
Other - Middle Name:
Other - Last Name:THIRUGNANA SAMBANDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2206 MARY LN
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2358
Mailing Address - Country:US
Mailing Address - Phone:716-208-9631
Mailing Address - Fax:
Practice Address - Street 1:3538 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2246
Practice Address - Country:US
Practice Address - Phone:219-316-7470
Practice Address - Fax:219-386-2505
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251X0800X
IN05009893A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic