Provider Demographics
NPI:1932171097
Name:REDDY CARE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:REDDY CARE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SOMAREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:516-829-0030
Mailing Address - Street 1:475 NORTHERN BLVD
Mailing Address - Street 2:STE 11
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4802
Mailing Address - Country:US
Mailing Address - Phone:516-829-0030
Mailing Address - Fax:516-466-7723
Practice Address - Street 1:475 NORTHERN BLVD
Practice Address - Street 2:STE 11
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4802
Practice Address - Country:US
Practice Address - Phone:516-829-0030
Practice Address - Fax:516-466-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0231191174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02227741Medicaid
NY113423593OtherPHCS
NY2153187OtherUNITED HEALTHCARE
NY7619OtherCAPITOL
NY9442659OtherCIGNA HEALTHPLANS
NY113423593OtherMULTIPLAN
NYP2540752OtherOXFORD HEALTHPLANS
NY023119OtherVYTRA HEALTHCARE
NY113423593OtherDEVON
NY113423593OtherCORVEL
NY1961313OtherFIRSTHEALTH
NY00000091742OtherBETTERHEALTH
NYQT1321OtherBLUE CROSS BLUE SHIELD
NY168391OtherELDERPLAN
NY212146DOtherMAGNACARE
NY213410N01OtherHIP HEALTHPLANS
NY080023119NY03OtherANTHEM HEALTHCARE
NY2153187OtherUNITED HEALTHCARE
NYQ1W8Y1Medicare ID - Type Unspecified