Provider Demographics
NPI:1962489385
Name:MANDAVA, LAKSHMI BHAVANI (PT)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:BHAVANI
Last Name:MANDAVA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 TURNPIKE ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845
Mailing Address - Country:US
Mailing Address - Phone:978-686-9688
Mailing Address - Fax:978-688-2163
Practice Address - Street 1:575 TURNPIKE ST
Practice Address - Street 2:SUITE 14
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845
Practice Address - Country:US
Practice Address - Phone:978-686-9688
Practice Address - Fax:978-688-2163
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist