Provider Demographics
NPI:1891025193
Name:KORIPALLI CHIRANJEEVI, SANDHYA (RPT)
Entity Type:Individual
Prefix:MRS
First Name:SANDHYA
Middle Name:
Last Name:KORIPALLI CHIRANJEEVI
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20319 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1411
Mailing Address - Country:US
Mailing Address - Phone:248-476-8911
Mailing Address - Fax:248-476-8913
Practice Address - Street 1:20319 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1411
Practice Address - Country:US
Practice Address - Phone:248-476-8911
Practice Address - Fax:248-476-8913
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383454355OtherTAX ID
MI383606482OtherINSPIRATIONS TAX ID