Provider Demographics
NPI:1245407725
Name:SARVADEVABHATLA, LALITHA V (PT)
Entity Type:Individual
Prefix:
First Name:LALITHA
Middle Name:V
Last Name:SARVADEVABHATLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LALITHA
Other - Middle Name:VENKATA
Other - Last Name:KOTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1420 N MARSHALL ST
Mailing Address - Street 2:#204
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1420 N MARSHALL ST
Practice Address - Street 2:#204
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2761
Practice Address - Country:US
Practice Address - Phone:414-421-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012117225100000X
WI10678-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist