Provider Demographics
NPI:1255604344
Name:ALLALA, THIRUPATHI REDDY
Entity type:Individual
Prefix:
First Name:THIRUPATHI
Middle Name:REDDY
Last Name:ALLALA
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 1:2119 S LOVINGTON DR
Mailing Address - Street 2:APT 201
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-4352
Mailing Address - Country:US
Mailing Address - Phone:813-476-1780
Mailing Address - Fax:
Practice Address - Street 1:2243 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-5644
Practice Address - Country:US
Practice Address - Phone:586-573-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist