Healthcare Provider Details

I. General information

NPI: 1497650451
Provider Name (Legal Business Name): MANIKANTH REDDY MALE PT,DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 GAYLORD PKWY APT 1340
FRISCO TX
75034-8621
US

IV. Provider business mailing address

8100 GAYLORD PKWY APT 1340
FRISCO TX
75034-8621
US

V. Phone/Fax

Practice location:
  • Phone: 972-848-9602
  • Fax: 972-587-9414
Mailing address:
  • Phone: 972-848-9602
  • Fax: 972-587-9414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1409103
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: