Provider Demographics
NPI:1831353119
Name:KAMBHAM, PADMALATHA I (RPT)
Entity type:Individual
Prefix:
First Name:PADMALATHA
Middle Name:
Last Name:KAMBHAM
Suffix:I
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S MORRISON RD
Mailing Address - Street 2:APT # 309
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4043
Mailing Address - Country:US
Mailing Address - Phone:248-681-5574
Mailing Address - Fax:
Practice Address - Street 1:4301 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-1190
Practice Address - Country:US
Practice Address - Phone:765-282-0207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009427A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist