Provider Demographics
NPI:1518014828
Name:MANNEPALLI, SIRISHA (PT)
Entity Type:Individual
Prefix:
First Name:SIRISHA
Middle Name:
Last Name:MANNEPALLI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SIRISHA
Other - Middle Name:
Other - Last Name:PUTUMBAKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:3981 WELLINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-1172
Mailing Address - Country:US
Mailing Address - Phone:727-787-2049
Mailing Address - Fax:
Practice Address - Street 1:3981 WELLINGTON PKWY
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-1172
Practice Address - Country:US
Practice Address - Phone:727-787-2049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2017-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011712225100000X
FLPT 32170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501011712OtherPHYSICAL THERAPY
FLPT 32170OtherPHYSICAL THERAPY LICENSE