Provider Demographics
NPI:1922708429
Name:KODALI, CHANDRASHEKHAR
Entity Type:Individual
Prefix:
First Name:CHANDRASHEKHAR
Middle Name:
Last Name:KODALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 CORINTHIAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1442
Mailing Address - Country:US
Mailing Address - Phone:215-292-1221
Mailing Address - Fax:
Practice Address - Street 1:850 CORINTHIAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-1442
Practice Address - Country:US
Practice Address - Phone:215-292-1221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic