Provider Demographics
NPI:1629297007
Name:BOMMINENI, GEETADEVI (RPT)
Entity Type:Individual
Prefix:
First Name:GEETADEVI
Middle Name:
Last Name:BOMMINENI
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:GEETADEVI
Other - Middle Name:
Other - Last Name:BUJULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11902 BIRD KEY BLVD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-4144
Mailing Address - Country:US
Mailing Address - Phone:317-876-0598
Mailing Address - Fax:
Practice Address - Street 1:8060 KNUE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1976
Practice Address - Country:US
Practice Address - Phone:610-834-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008520A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist