Individual
SHIVA GUNDAVARAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Contact information
Practice address
3180 MAIN ST STE 303, BRIDGEPORT, CT 06606-4237
(203) 373-1593
Mailing address
3180 MAIN ST STE 303, BRIDGEPORT, CT 06606-4237
(203) 373-1593
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
007938
CT
Other
Enumeration date
03/15/2014
Last updated
03/15/2014
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