Provider Demographics
NPI:1780700674
Name:BANDI, DEEPTHI REDDY (PT)
Entity type:Individual
Prefix:
First Name:DEEPTHI
Middle Name:REDDY
Last Name:BANDI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12114 LAZIO LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-2214
Mailing Address - Country:US
Mailing Address - Phone:302-312-3868
Mailing Address - Fax:
Practice Address - Street 1:7210 LINKSIDE POINT DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5154
Practice Address - Country:US
Practice Address - Phone:972-547-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002085225100000X
TX1249388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist