Provider Demographics
NPI:1508353111
Name:NADIKATTU, SUDHEER REDDY
Entity Type:Individual
Prefix:
First Name:SUDHEER
Middle Name:REDDY
Last Name:NADIKATTU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9908 VALE RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-4074
Mailing Address - Country:US
Mailing Address - Phone:812-756-8696
Mailing Address - Fax:
Practice Address - Street 1:5425 WESTERN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2931
Practice Address - Country:US
Practice Address - Phone:202-966-6667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist