Provider Demographics
NPI:1417120114
Name:MADDIRALA, SIREESHA (PT)
Entity Type:Individual
Prefix:MRS
First Name:SIREESHA
Middle Name:
Last Name:MADDIRALA
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 1:500 S UNIVERSITY AVE
Mailing Address - Street 2:SUITE NUMBER A-23
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5302
Mailing Address - Country:US
Mailing Address - Phone:501-558-9099
Mailing Address - Fax:501-558-9091
Practice Address - Street 1:500 S UNIVERSITY AVE
Practice Address - Street 2:SUITE NUMBER A-23
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5302
Practice Address - Country:US
Practice Address - Phone:501-558-9099
Practice Address - Fax:501-558-9091
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 2899174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist