Provider Demographics
NPI:1417144676
Name:KADIYALA, MADHURI (PT)
Entity Type:Individual
Prefix:
First Name:MADHURI
Middle Name:
Last Name:KADIYALA
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:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46308-0948
Mailing Address - Country:US
Mailing Address - Phone:219-662-2224
Mailing Address - Fax:219-661-8892
Practice Address - Street 1:2914 HIGHWAY AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-1656
Practice Address - Country:US
Practice Address - Phone:219-923-8713
Practice Address - Fax:219-923-8714
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008550A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist