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General NPI Number Information
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NPI Number | 1285417329
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Entity Type | Organization
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Legal Business Name | NV HEALTH ENTERPRISE LLC
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 6525 E 82ND ST STE 103
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-1545
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Country | US
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Telephone | 317-348-4949
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Fax | 317-537-2089
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Provider Business Mailing Address
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Address Line | 6525 E 82ND ST STE 103
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-1545
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Country | US
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Telephone | 317-348-4949
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Fax | 317-537-2089
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Authorized Official
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Title or Position | OWNER
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Name | GOPI KRISHNA GORANTLA
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Credential |
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Telephone | 317-513-2886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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