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General NPI Number Information
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NPI Number | 1629572656
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Entity Type | Individual
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Provider Name | JYOTHI PADALA
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Gender | Female
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 03/23/2018
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Provider Practice Location Address
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Address Line | 21450 ARCHWOOD CIR
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-4127
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Country | US
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Telephone | 248-426-6928
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Fax |
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Provider Business Mailing Address
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Address Line | 43779 PRESTWICK CIR S
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City | NORTHVILLE
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State | MI
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Zip | 48168-5016
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Country | US
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Telephone | 618-541-7837
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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 | 5501013783
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License Number State | MI
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