Provider Demographics
NPI:1881415990
Name:CHETTY, MEENA MEYYAPPAN
Entity type:Individual
Prefix:
First Name:MEENA
Middle Name:MEYYAPPAN
Last Name:CHETTY
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 1:3905 JOHNS CREEK CT STE 250
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1226
Mailing Address - Country:US
Mailing Address - Phone:678-230-2194
Mailing Address - Fax:
Practice Address - Street 1:3905 JOHNS CREEK CT STE 250
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1226
Practice Address - Country:US
Practice Address - Phone:678-230-2194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT017460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist