MEDICARE: BHAVYA THOTA

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	5501017712	MI

General Provider Information

NPI Number	:	1326581729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BHAVYA THOTA

Provider Business Mailing Address
First Line	:	38765 MOUND RD
Second Line	:	SUITE 101
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	38765 MOUND RD
Second Line	:	SUITE 101
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3209
Country	:	US
Telephone Number	:	248-727-2057
Fax Number	:

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

Provider Enumeration Date	:	12/02/2016
Last Update Date	:	12/02/2016

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Directions to “ BHAVYA THOTA ” Practice Location

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