MEDICARE: KALYAN CHAKRAVARTHI PEDDINENI

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	037525	NY

General Provider Information

NPI Number	:	1689339335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALYAN CHAKRAVARTHI PEDDINENI

Provider Business Mailing Address
First Line	:	382 BALDWIN AVE APT 3
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2054
Country	:	US
Telephone Number	:	240-782-5141
Fax Number	:

Provider Business Practice Location Address
First Line	:	382 BALDWIN AVE APT 3
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2054
Country	:	US
Telephone Number	:	240-782-5141
Fax Number	:

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

Provider Enumeration Date	:	11/07/2021
Last Update Date	:	06/14/2026

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