Provider Demographics
NPI:1972264513
Name:VODELA, VINAY KUMAR (PT)
Entity Type:Individual
Prefix:
First Name:VINAY
Middle Name:KUMAR
Last Name:VODELA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 COBBLESTONE LN
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-1899
Mailing Address - Country:US
Mailing Address - Phone:434-660-7039
Mailing Address - Fax:
Practice Address - Street 1:1063 COBBLESTONE LN
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-1899
Practice Address - Country:US
Practice Address - Phone:434-660-7039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist