Provider Demographics
NPI:1558485920
Name:MUDIREDDY, CHAITANYA K (PT)
Entity Type:Individual
Prefix:
First Name:CHAITANYA
Middle Name:K
Last Name:MUDIREDDY
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 1:2800 W PARKER RD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-9194
Mailing Address - Country:US
Mailing Address - Phone:972-983-3840
Mailing Address - Fax:
Practice Address - Street 1:12222 N CENTRAL EXPY STE 115
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3757
Practice Address - Country:US
Practice Address - Phone:972-546-0411
Practice Address - Fax:972-559-1867
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027697171W00000X
TX1196173225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171W00000XOther Service ProvidersContractor