Provider Demographics
NPI:1396089736
Name:SANKARAN, SRINIVASAN K
Entity type:Individual
Prefix:
First Name:SRINIVASAN
Middle Name:K
Last Name:SANKARAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6012 PINE BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-6842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:IN
Practice Address - Zip Code:46120-8531
Practice Address - Country:US
Practice Address - Phone:765-795-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003000A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist