Provider Demographics
NPI:1164276044
Name:NALLA, KRANTHI REDDY (PT, MS)
Entity Type:Individual
Prefix:MR
First Name:KRANTHI REDDY
Middle Name:
Last Name:NALLA
Suffix:
Gender:M
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 COLUMBIA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-4557
Mailing Address - Country:US
Mailing Address - Phone:302-580-9735
Mailing Address - Fax:
Practice Address - Street 1:31 E 32ND ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5595
Practice Address - Country:US
Practice Address - Phone:212-759-2282
Practice Address - Fax:212-379-2123
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051970225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist