MEDICARE: SUNESH KUMAR REDDY BANDI DOCTOR OF PT

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	38964	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38964	OTHER	CA	P.T BOARD OF CALIFORNIA

General Provider Information

NPI Number	:	1770036113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNESH KUMAR REDDY BANDI DOCTOR OF PT

Provider Business Mailing Address
First Line	:	42873 EVERGLADES PARK DR
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94538-3977
Country	:	US
Telephone Number	:	909-232-6719
Fax Number	:

Provider Business Practice Location Address
First Line	:	42873 EVERGLADES PARK DR
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94538-3977
Country	:	US
Telephone Number	:	909-232-6719
Fax Number	:

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

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	06/24/2020

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