Provider Demographics
NPI:1881085249
Name:MANAPRAGADA, NISHI (P T)
Entity type:Individual
Prefix:
First Name:NISHI
Middle Name:
Last Name:MANAPRAGADA
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 RIVIERA PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3638
Mailing Address - Country:US
Mailing Address - Phone:510-299-6247
Mailing Address - Fax:
Practice Address - Street 1:530 RIVIERA PL
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3638
Practice Address - Country:US
Practice Address - Phone:510-299-6247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist