Healthcare Provider Details

I. General information

NPI: 1730306341
Provider Name (Legal Business Name): SARANYA NAGIREDDY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15393 ACKERLEY DR
FORTVILLE IN
46040
US

IV. Provider business mailing address

15393 ACKERLEY15393
FORTVILLE IN
46040
US

V. Phone/Fax

Practice location:
  • Phone: 317-645-1123
  • Fax:
Mailing address:
  • Phone: 317-645-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05008673A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: