Provider Demographics
NPI:1295981918
Name:GUNDA, SHASHI KRISHNA (DPT)
Entity type:Individual
Prefix:
First Name:SHASHI
Middle Name:KRISHNA
Last Name:GUNDA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 E JOLLY RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-8552
Mailing Address - Country:US
Mailing Address - Phone:517-272-5133
Mailing Address - Fax:517-272-5138
Practice Address - Street 1:3370 E JOLLY RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-8552
Practice Address - Country:US
Practice Address - Phone:517-272-5133
Practice Address - Fax:517-272-5138
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist