Provider Demographics
NPI:1538391487
Name:SANTHANAM, GAYATHRI (PT)
Entity type:Individual
Prefix:
First Name:GAYATHRI
Middle Name:
Last Name:SANTHANAM
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 1:10008 MULHOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7012
Mailing Address - Country:US
Mailing Address - Phone:773-679-1631
Mailing Address - Fax:
Practice Address - Street 1:10008 MULHOLLAND DR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-7012
Practice Address - Country:US
Practice Address - Phone:773-679-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist