Provider Demographics
NPI:1245589928
Name:KONDAPALLI, SUBHADRA (PT)
Entity Type:Individual
Prefix:
First Name:SUBHADRA
Middle Name:
Last Name:KONDAPALLI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21707 KINGSLAND BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2519
Mailing Address - Country:US
Mailing Address - Phone:281-398-8235
Mailing Address - Fax:281-398-8246
Practice Address - Street 1:21707 KINGSLAND BLVD STE 101
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2519
Practice Address - Country:US
Practice Address - Phone:281-398-8235
Practice Address - Fax:281-398-8246
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014450225100000X
TX1356470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist