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General NPI Number Information
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NPI Number | 1053185561
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Entity Type | Individual
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Provider Name | LAKSHMI SRUTHI DATLA
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Gender | Female
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Dates
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Enumeration Date | 11/14/2023
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 11 N TOMPKINS SQ
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City | DOWNINGTOWN
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State | PA
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Zip | 19335-3173
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Country | US
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Telephone | 234-567-1456
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Fax |
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Provider Business Mailing Address
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Address Line | 11 N TOMPKINS SQ
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City | DOWNINGTOWN
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State | PA
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Zip | 19335-3173
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Country | US
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Telephone | 234-567-1456
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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