# SUSEELA SAMUDRALA MD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Metro Rehab Physicians
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629032081
- **Authorized official:** MARINA MCROY (OFFICE MANAGER)
- **Authorized official phone:** (314) 355-7880

## Contact information

- **Practice address:** 11125 DUNN ROAD, SUITE 311, ST LOUIS, MO 63136
- **Practice address phone:** (314) 653-5730
- **Practice address fax:** (314) 355-8899
- **Mailing address:** 11125 DUNN ROAD, SUITE 311, ST LOUIS, MO 63136
- **Mailing address phone:** (314) 653-5730
- **Mailing address fax:** (314) 355-8899

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | R8290 | MO | Yes |

## Other

- **Enumeration date:** 04/13/2006
- **Last updated:** 04/12/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 507527000 | — | MO |