Provider Demographics
NPI:1538489513
Name:VENNELAKANTI, HARICHANDRA (MS, DPT)
Entity Type:Individual
Prefix:
First Name:HARICHANDRA
Middle Name:
Last Name:VENNELAKANTI
Suffix:
Gender:M
Credentials:MS, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 W 287 BYP
Mailing Address - Street 2:APT: 331
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5227
Mailing Address - Country:US
Mailing Address - Phone:662-202-5943
Mailing Address - Fax:
Practice Address - Street 1:2300 S OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-6841
Practice Address - Country:US
Practice Address - Phone:972-875-8643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014952225100000X
IN05010246A225100000X
TX1245282225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist