Provider Demographics
NPI:1083038897
Name:PURIMETLA, PRANEETH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:PRANEETH
Middle Name:
Last Name:PURIMETLA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 W BELMONT AVE
Mailing Address - Street 2:UNIT 1W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6561
Mailing Address - Country:US
Mailing Address - Phone:773-883-2337
Mailing Address - Fax:773-883-2336
Practice Address - Street 1:2250 W BELMONT AVE
Practice Address - Street 2:UNIT 1W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6561
Practice Address - Country:US
Practice Address - Phone:773-888-3233
Practice Address - Fax:773-883-2336
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist