Provider Demographics
NPI:1053647594
Name:MADDALI, NAGA PRASHANT (PT)
Entity type:Individual
Prefix:MR
First Name:NAGA
Middle Name:PRASHANT
Last Name:MADDALI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5428 METROPOLITAN PKWY
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4103
Mailing Address - Country:US
Mailing Address - Phone:586-977-0001
Mailing Address - Fax:586-977-0002
Practice Address - Street 1:5428 METROPOLITAN PKWY
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4103
Practice Address - Country:US
Practice Address - Phone:586-977-0001
Practice Address - Fax:586-977-0002
Is Sole Proprietor?:No
Enumeration Date:2009-10-18
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014273225100000X
IN05009974A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist