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General NPI Number Information
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NPI Number | 1376190488
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Entity Type | Individual
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Provider Name | SRILATHA MITTAPELLI
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Gender | Female
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 4605 EAGLE DR
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City | JACKSON
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State | MI
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Zip | 49201-9747
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Country | US
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Telephone | 517-416-8704
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Fax |
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Provider Business Mailing Address
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Address Line | 826 N MARTIN LUTHER KING JR DR
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City | JACKSON
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State | MI
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Zip | 49202-2558
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Country | US
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Telephone | 800-379-1600
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501019529
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502005826
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License Number State | MI
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