Provider Demographics
NPI:1629196266
Name:THAMBI, SRIDEVI
Entity Type:Individual
Prefix:
First Name:SRIDEVI
Middle Name:
Last Name:THAMBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 SPICEWOOD SPRINGS RD APT 620
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4499
Mailing Address - Country:US
Mailing Address - Phone:860-324-1138
Mailing Address - Fax:
Practice Address - Street 1:359 VILLAGE COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-4448
Practice Address - Country:US
Practice Address - Phone:512-277-6405
Practice Address - Fax:512-277-6406
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1282583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist