Provider Demographics
NPI:1053536607
Name:GANJI, MURALIDHAR (MSPT)
Entity type:Individual
Prefix:MR
First Name:MURALIDHAR
Middle Name:
Last Name:GANJI
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5410 W KELLER RD
Mailing Address - Street 2:# 6, MILLPOND APARTMENTS
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-8887
Mailing Address - Country:US
Mailing Address - Phone:203-843-8318
Mailing Address - Fax:
Practice Address - Street 1:5410 W KELLER RD
Practice Address - Street 2:# 6, MILLPOND APARTMENTS
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-8887
Practice Address - Country:US
Practice Address - Phone:203-843-8318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009008A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist