Healthcare Provider Details

I. General information

NPI: 1881409902
Provider Name (Legal Business Name): JAYA SRINATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 ALLIANCE BLVD STE 200
PLANO TX
75093-5578
US

IV. Provider business mailing address

1912 HARRINGTON DR
PLANO TX
75075-2714
US

V. Phone/Fax

Practice location:
  • Phone: 469-606-1378
  • Fax:
Mailing address:
  • Phone: 614-580-8104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1231173
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number1231173
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: