Active NPI
Sowjanya Pinnamaneni, P.T.
- Physical Therapist
- Crystal Lake, IL
National Provider Identifier
1730203266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070.016354
- Practice address
- 650 Dakota St
Suite a
Crystal Lake, IL 60012-3744 - Phone
- (815) 455-6000
- Fax
- (815) 477-2226
- NPI assigned
- Mar 19, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070.016354 | IL | Primary |
Addresses
Primary practice location
650 Dakota St
Suite a
Crystal Lake, IL 60012-3744
Mailing address
650 Dakota St
Suite a
Crystal Lake, IL 60012-3744
Phone (815) 455-6000
Other names 1
- Sowjanya Suryadevara
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.016354 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210723200000",
"number": "1730203266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 DAKOTA ST",
"address_2": "SUITE A",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600123744",
"telephone_number": "815-455-6000",
"fax_number": "815-477-2226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 DAKOTA ST",
"address_2": "SUITE A",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600123744",
"telephone_number": "815-455-6000",
"fax_number": "815-477-2226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PINNAMANENI",
"first_name": "SOWJANYA",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-19",
"last_updated": "2008-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.016354",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SOWJANYA",
"last_name": "SURYADEVARA",
"credential": "P.T.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Crystal Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.