=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245589928
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUBHADRA KONDAPALLI PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2012
-----------------------------------------------------
Last Update Date | 09/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21707 KINGSLAND BLVD STE 101
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77450-2519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-398-8235
-----------------------------------------------------
Fax | 281-398-8246
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21707 KINGSLAND BLVD STE 101
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77450-2519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-398-8235
-----------------------------------------------------
Fax | 281-398-8246
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 070014450
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1356470
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------