Healthcare Provider Details

I. General information

NPI: 1003041963
Provider Name (Legal Business Name): MUPPIDI REHAB, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 WALNUT HILL LN
DALLAS TX
75231
US

IV. Provider business mailing address

PO BOX 678303
DALLAS TX
75267-8303
US

V. Phone/Fax

Practice location:
  • Phone: 214-345-6789
  • Fax:
Mailing address:
  • Phone: 817-284-9850
  • Fax: 817-284-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberL5064
License Number StateTX

VIII. Authorized Official

Name: DR. MADHAVI REDDY MUPPIDI
Title or Position: OWNER
Credential: M.D.
Phone: 817-284-9850