Provider Demographics
NPI:1003046392
Name:KONKI, NAMITHA
Entity Type:Individual
Prefix:MISS
First Name:NAMITHA
Middle Name:
Last Name:KONKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2643 BEACON HILL CT
Mailing Address - Street 2:102
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-4225
Mailing Address - Country:US
Mailing Address - Phone:248-202-9753
Mailing Address - Fax:
Practice Address - Street 1:2643 BEACON HILL CT
Practice Address - Street 2:102
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-4225
Practice Address - Country:US
Practice Address - Phone:248-202-9753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist