Provider Demographics
NPI:1457812760
Name:KODALI, VINITHA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:VINITHA
Middle Name:
Last Name:KODALI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:VINITHA
Other - Middle Name:
Other - Last Name:SUNKARAPALLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 CENTERPOINT PKWY
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-3116
Mailing Address - Country:US
Mailing Address - Phone:248-857-6776
Mailing Address - Fax:248-857-7102
Practice Address - Street 1:3000 CENTERPOINT PKWY
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-3116
Practice Address - Country:US
Practice Address - Phone:248-857-6776
Practice Address - Fax:248-857-7102
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30510225100000X
MI5501019552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501019552OtherPT LICENSE
AZLPT30510OtherPHYSICAL THERAPY LICENSE