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NPI Code Detail

MEDICARE: JYOTHSNA VANGURU PT

MEDICARE: JYOTHSNA VANGURU 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
1225100000XPhysical Therapist5501013357MI
2225100000XPhysical Therapist05009328AIN

General Provider Information

NPI Number : 1447407580
Entity Type Code : Individual
Provider Name (Legal Business Name) : JYOTHSNA VANGURU PT
Provider Business Mailing Address
First Line : 4350 MADISON AVE APT 308
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-1571
Country : US
Telephone Number : 701-212-6513
Fax Number :
Provider Business Practice Location Address
First Line : 4102 SHORE DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46254-2608
Country : US
Telephone Number : 317-347-9051
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2008
Last Update Date : 01/04/2024

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Directions to “ JYOTHSNA VANGURU PT” Practice Location

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