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NPI Code Detail

MEDICARE: JAYACHANDRA BOMMAREDDY

MEDICARE: JAYACHANDRA BOMMAREDDY
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
1225100000XPhysical Therapist5501013421MI

General Provider Information

NPI Number : 1790289494
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAYACHANDRA BOMMAREDDY
Provider Business Mailing Address
First Line : 3198 FANTAIL DR
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48309-4292
Country : US
Telephone Number : 510-565-4554
Fax Number :
Provider Business Practice Location Address
First Line : 17001 17 MILE RD
Second Line :
City : CLINTON TOWNSHIP
State : MI
Zip : 48038-2801
Country : US
Telephone Number : 586-286-7100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2018
Last Update Date : 03/19/2018

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Directions to “ JAYACHANDRA BOMMAREDDY ” Practice Location

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