Provider Demographics
NPI:1306207410
Name:NIMMALA, SWETHA (PT)
Entity Type:Individual
Prefix:
First Name:SWETHA
Middle Name:
Last Name:NIMMALA
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 1:10018 CARRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-8354
Mailing Address - Country:US
Mailing Address - Phone:229-200-8880
Mailing Address - Fax:
Practice Address - Street 1:21907 WESTERNPORT RD SW
Practice Address - Street 2:STE 1
Practice Address - City:WESTERNPORT
Practice Address - State:MD
Practice Address - Zip Code:21562-2234
Practice Address - Country:US
Practice Address - Phone:301-786-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist