Mallikarjuna Prasad Suryamoni, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

25836 Issued in FL

Practice address

1550 Jess Parrish CT
Titusville, FL 32796-2147

Phone

(321) 269-2200

NPI assigned

Jan 19, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Healthpro Heritage Rehab and Fitness LLCGroup PAC ID 6507832573, 976 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Healthpro Heritage Rehab & Fitness, LLC

  • Physical Therapist
  • Coral Gables, FL
  • NPI 1871972653
  Medicare reassignment Care Compare group NPD
• Healthpro Heritage Rehab & Fitness, LLC

  • Physical Therapist
  • Independence, MO
  • NPI 1871072462
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326931200000",
    "number": "1265703425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3515 SABLE PALM LN UNIT L",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327805581",
            "telephone_number": "618-402-8723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 JESS PARRISH CT",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962147",
            "telephone_number": "321-269-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURYAMONI",
        "first_name": "MALLIKARJUNA",
        "middle_name": "PRASAD",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-01-19",
        "last_updated": "2012-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "25836",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "0500977A",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501013526",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer D Stowers, M.A., L.M.H.C.
• Adam Suarez
• Nadia Sulieman, DMD
• Ajmal Aziz Sultan, MD
• Paula Sumner, LMHC
• Michael O Sutherin
• Athanasia Svenning
• Lon Swatchick
• Lisa Ann Sweeny, LMHC
• Zachary Sykes, PTA

• Physical Therapist in Titusville, FL
• Providers in Titusville, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.