Provider Demographics
NPI:1497120661
Name:REKULAPALLY, SRIKRISHNA (PHYSICAL THRERAPIST)
Entity Type:Individual
Prefix:
First Name:SRIKRISHNA
Middle Name:
Last Name:REKULAPALLY
Suffix:
Gender:M
Credentials:PHYSICAL THRERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12702 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2959
Mailing Address - Country:US
Mailing Address - Phone:248-826-8999
Mailing Address - Fax:
Practice Address - Street 1:12702 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2959
Practice Address - Country:US
Practice Address - Phone:248-690-6685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty