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NPI Code Detail

MEDICARE: KRISHNA LATHA MITTAPELLI PT

MEDICARE: KRISHNA LATHA MITTAPELLI 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
12251G0304XGeriatric Physical Therapist

General Provider Information

NPI Number : 1942704572
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISHNA LATHA MITTAPELLI PT
Provider Business Mailing Address
First Line : 4381 WILLOW CREEK DR
Second Line :
City : TROY
State : MI
Zip : 48085-5727
Country : US
Telephone Number : 419-215-0503
Fax Number :
Provider Business Practice Location Address
First Line : 6700 W OUTER DR
Second Line :
City : DETROIT
State : MI
Zip : 48235-2724
Country : US
Telephone Number : 313-836-1700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2018
Last Update Date : 03/20/2018

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Directions to “ KRISHNA LATHA MITTAPELLI PT” Practice Location

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