Provider Demographics
NPI:1285185702
Name:KANDULA, SRAVANTHI
Entity Type:Individual
Prefix:
First Name:SRAVANTHI
Middle Name:
Last Name:KANDULA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 THAYER CT
Mailing Address - Street 2:SUITE 500 C
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-6183
Mailing Address - Country:US
Mailing Address - Phone:678-459-3745
Mailing Address - Fax:
Practice Address - Street 1:3600 THAYER CT
Practice Address - Street 2:SUITE 500 C
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-6183
Practice Address - Country:US
Practice Address - Phone:630-870-4735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist