Provider Demographics
NPI:1740430339
Name:GUMMADI, NEHA M (BS)
Entity Type:Individual
Prefix:
First Name:NEHA
Middle Name:M
Last Name:GUMMADI
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:NEHA
Other - Middle Name:A
Other - Last Name:MOGHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1118 VERMONT DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1961 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48302-0246
Practice Address - Country:US
Practice Address - Phone:248-319-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501013926OtherSTATE LICENSE