Provider Demographics
NPI:1942535331
Name:ANNEPU, JAGADISH
Entity Type:Individual
Prefix:
First Name:JAGADISH
Middle Name:
Last Name:ANNEPU
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:PO BOX 421765
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46242-1765
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11417 N MEADOWBEND DR
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:IN
Practice Address - Zip Code:46157-8111
Practice Address - Country:US
Practice Address - Phone:317-652-0473
Practice Address - Fax:317-996-2733
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist