Provider Demographics
NPI:1629762638
Name:ANVITHA, FNU (PT)
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:ANVITHA
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 1:4800 KELLER SPRINGS RD APT 1321
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6525
Mailing Address - Country:US
Mailing Address - Phone:472-167-3023
Mailing Address - Fax:
Practice Address - Street 1:5881 VIRGINIA PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5402
Practice Address - Country:US
Practice Address - Phone:972-548-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1356100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist