Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT014066 | GA |
NPI | 1578238226 |
---|---|
Provider Name | Dr. Shantha Nithiananda |
First Address | Atlanta, GA 30339 |
Second Address | Atlanta, GA 30342-2636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2021 |
Last Update Date | 14/08/2021 |