Provider Demographics
NPI:1770036113
Name:BANDI, SUNESH KUMAR REDDY (DOCTOR OF PT)
Entity Type:Individual
Prefix:
First Name:SUNESH
Middle Name:KUMAR REDDY
Last Name:BANDI
Suffix:
Gender:M
Credentials:DOCTOR OF PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42873 EVERGLADES PARK DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-3977
Mailing Address - Country:US
Mailing Address - Phone:909-232-6719
Mailing Address - Fax:
Practice Address - Street 1:42873 EVERGLADES PARK DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-3977
Practice Address - Country:US
Practice Address - Phone:909-232-6719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38964OtherP.T BOARD OF CALIFORNIA