Individual
ADITI SURYAKANT DATTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4600 W WASHINGTON ST, SOUTH BEND, IN 46619-2320
(574) 282-1294
Mailing address
402 W GROVE ST, MISHAWAKA, IN 46545-6044
(817) 733-6708
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05010293A
IN
Other
Enumeration date
05/19/2023
Last updated
05/19/2023
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