Provider Demographics
NPI:1265173801
Name:JONNALAGADDA, KRISHNA CHAITANYA
Entity type:Individual
Prefix:
First Name:KRISHNA CHAITANYA
Middle Name:
Last Name:JONNALAGADDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FARM HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-1474
Mailing Address - Country:US
Mailing Address - Phone:312-618-5933
Mailing Address - Fax:
Practice Address - Street 1:359 HIGH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2617
Practice Address - Country:US
Practice Address - Phone:214-491-0173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9993225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant