Provider Demographics
NPI:1407301864
Name:ADUDODLA, SRUTHI
Entity Type:Individual
Prefix:
First Name:SRUTHI
Middle Name:
Last Name:ADUDODLA
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 1:1820 PLEASANTDALE RD
Mailing Address - Street 2:APT 5
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-5738
Mailing Address - Country:US
Mailing Address - Phone:330-651-6032
Mailing Address - Fax:
Practice Address - Street 1:1820 PLEASANTDALE RD
Practice Address - Street 2:APT 5
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-5738
Practice Address - Country:US
Practice Address - Phone:330-651-6032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025129225100000X
DEJ1-0003407225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist