Provider Demographics
NPI:1194192344
Name:REDDY, ANISH (DPT)
Entity Type:Individual
Prefix:
First Name:ANISH
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 ROUTE 113
Mailing Address - Street 2:STE 6
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1000
Mailing Address - Country:US
Mailing Address - Phone:732-494-0895
Mailing Address - Fax:
Practice Address - Street 1:3830 PARK AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2562
Practice Address - Country:US
Practice Address - Phone:732-494-0895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0268752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic