Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MR. JAYA PRAKASH BODDU, PT
Active Sole ProprietorMR. JAYA PRAKASH BODDU, PT is a Physical Therapy Assistant healthcare provider located in PORTLAND, Michigan. NPI 1023235777 is currently active in the NPPES registry. Verify at CMS.
Physical Therapy Assistant · PORTLAND, MI
Registration Details
- NPI Number
- 1023235777
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Apr 20, 2007 (19.137981365783 yrs)
- Last Updated
- Jul 8, 2007
- License
-
5501005495 (MI)
- Sole Proprietor
- Yes
Practice Information
- Address
-
1447 E GRAND RIVER AVEHEALTH SOURCE PHYSICAL THERAPY CENTER,INC.PORTLAND, MI, 488759687Browse MI providers · Browse ZIP 48875
- Phone
- 5176471000
- Fax
- 5176471100
- Primary Specialty
-
Physical Therapy Assistant
225100000X
Other Physical Therapy Assistant Providers in PORTLAND, MI
| Name | Credential | NPI |
|---|---|---|
| DR. JESUDIAN BODDU | DPT | 1831315712 |
| ERICA FORESMAN | DPT | 1164002440 |
| LAUREN BEERS | DPT | 1093558231 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.