Healthcare Provider Details

I. General information

NPI: 1326700386
Provider Name (Legal Business Name): INDU REDDY ENUKONDA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 E MARKET ST STE 142
RHINEBECK NY
12572-1730
US

IV. Provider business mailing address

16 MAYBROOK RD STE L
CAMPBELL HALL NY
10916-2741
US

V. Phone/Fax

Practice location:
  • Phone: 845-876-3595
  • Fax:
Mailing address:
  • Phone: 845-636-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: