Provider Demographics
NPI:1891021200
Name:SANGIREDDY, RADHIKA (MSPT)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:SANGIREDDY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 VIETS ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-3354
Mailing Address - Country:US
Mailing Address - Phone:571-201-7107
Mailing Address - Fax:
Practice Address - Street 1:78 VIETS ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-3354
Practice Address - Country:US
Practice Address - Phone:571-201-7107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14.008496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist