Provider Demographics
NPI:1295985141
Name:CHANDURI, SHREEPAL (PT)
Entity type:Individual
Prefix:
First Name:SHREEPAL
Middle Name:
Last Name:CHANDURI
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 1:900 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-3300
Mailing Address - Country:US
Mailing Address - Phone:248-333-3335
Mailing Address - Fax:248-333-0276
Practice Address - Street 1:900 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-3300
Practice Address - Country:US
Practice Address - Phone:248-333-3335
Practice Address - Fax:248-333-0276
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist