Provider Demographics
NPI:1124529722
Name:SUTTHASRI, CHOLADA
Entity type:Individual
Prefix:
First Name:CHOLADA
Middle Name:
Last Name:SUTTHASRI
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 1:6201 OLIVER CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9581
Mailing Address - Country:US
Mailing Address - Phone:864-276-5682
Mailing Address - Fax:
Practice Address - Street 1:6201 OLIVER CREEK PKWY
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9581
Practice Address - Country:US
Practice Address - Phone:864-276-5682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13328225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty