Individual
SURYA NALLAMALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1670 WHITEHOUSE RD, IUKA, MS 38852-9013
(601) 605-6777
Mailing address
711 AVIGNON DR, RIDGELAND, MS 39157-5120
(601) 605-6777
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5668
MS
Other
Enumeration date
08/12/2020
Last updated
08/12/2020
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