Provider Demographics
NPI:1033355250
Name:THOTAKURA, SRIDEVI (PT)
Entity Type:Individual
Prefix:
First Name:SRIDEVI
Middle Name:
Last Name:THOTAKURA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-2244
Mailing Address - Country:US
Mailing Address - Phone:317-918-8269
Mailing Address - Fax:
Practice Address - Street 1:1021 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-2244
Practice Address - Country:US
Practice Address - Phone:317-918-8269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009700A225100000X
MI5501013947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist