MEDICARE: JYOTHI PADALA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501013783	MI

General Provider Information

NPI Number	:	1629572656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JYOTHI PADALA

Provider Business Mailing Address
First Line	:	43779 PRESTWICK CIR S
Second Line	:
City	:	NORTHVILLE
State	:	MI
Zip	:	48168-5016
Country	:	US
Telephone Number	:	618-541-7837
Fax Number	:

Provider Business Practice Location Address
First Line	:	21450 ARCHWOOD CIR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-4127
Country	:	US
Telephone Number	:	248-426-6928
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2018
Last Update Date	:	03/23/2018

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Directions to “ JYOTHI PADALA ” Practice Location

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