Provider Demographics
NPI:1164941290
Name:EPA, CHAITANYA KUMAR REDDY (PT,DPT)
Entity Type:Individual
Prefix:
First Name:CHAITANYA
Middle Name:KUMAR REDDY
Last Name:EPA
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 1:39045 POLO CLUB DR APT 204
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-5619
Mailing Address - Country:US
Mailing Address - Phone:703-853-8077
Mailing Address - Fax:
Practice Address - Street 1:2200 DORR RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8626
Practice Address - Country:US
Practice Address - Phone:517-347-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-09
Last Update Date:2017-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017579225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist