Provider Demographics
NPI:1821378720
Name:KORTEGERI, PUNEETH (PT)
Entity Type:Individual
Prefix:
First Name:PUNEETH
Middle Name:
Last Name:KORTEGERI
Suffix:
Gender:M
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:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:
Practice Address - Street 1:2059 SCENIC HWY N STE C
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6142
Practice Address - Country:US
Practice Address - Phone:470-568-2818
Practice Address - Fax:470-427-2480
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400054641Medicare PIN
NYA400054933Medicare PIN
NYA400054895Medicare PIN
NYA400055546Medicare PIN