Provider Demographics
NPI:1750598900
Name:ACHANTA, KAVITHA (LPT)
Entity type:Individual
Prefix:MRS
First Name:KAVITHA
Middle Name:
Last Name:ACHANTA
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 HURON DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108
Mailing Address - Country:US
Mailing Address - Phone:630-924-4954
Mailing Address - Fax:
Practice Address - Street 1:3800 HIGHLAND AVENUE
Practice Address - Street 2:SUITE 102 DOWNERS GROVE SURGERY AND TREATMENT CENTER PC
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515
Practice Address - Country:US
Practice Address - Phone:630-810-9966
Practice Address - Fax:630-810-9596
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist