Provider Demographics
NPI:1932985108
Name:MUTTINENI, SIREESHA (PT)
Entity Type:Individual
Prefix:MRS
First Name:SIREESHA
Middle Name:
Last Name:MUTTINENI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SIREESHA
Other - Middle Name:
Other - Last Name:KETHINENI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1960 BARRYMORE CMN APT C
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2379
Mailing Address - Country:US
Mailing Address - Phone:949-294-4659
Mailing Address - Fax:
Practice Address - Street 1:315 S ABBOTT AVE
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5254
Practice Address - Country:US
Practice Address - Phone:408-790-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist