Provider Demographics
NPI:1265023956
Name:CHELLA, ANANDA SAI KUMAR REDDY (DPT)
Entity Type:Individual
Prefix:
First Name:ANANDA SAI
Middle Name:KUMAR REDDY
Last Name:CHELLA
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 1:40 S DUNDALK AVE STE G3
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-4209
Mailing Address - Country:US
Mailing Address - Phone:410-285-0173
Mailing Address - Fax:410-285-0174
Practice Address - Street 1:40 S DUNDALK AVE STE G3
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-4209
Practice Address - Country:US
Practice Address - Phone:410-285-0173
Practice Address - Fax:410-285-0174
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist