MEDICARE: MR. NAGA PRASHANT MADDALI PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501014273	MI
2	225100000X	Physical Therapist	05009974A	IN

General Provider Information

NPI Number	:	1053647594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NAGA PRASHANT MADDALI PT

Provider Business Mailing Address
First Line	:	5428 METROPOLITAN PKWY
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4103
Country	:	US
Telephone Number	:	586-977-0001
Fax Number	:	586-977-0002

Provider Business Practice Location Address
First Line	:	5428 METROPOLITAN PKWY
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4103
Country	:	US
Telephone Number	:	586-977-0001
Fax Number	:	586-977-0002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2009
Last Update Date	:	10/18/2009

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