Basic Information
| Provider Information | |||||||||
| NPI: | 1003041963 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MUPPIDI REHAB, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 678303 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752678303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172849850 | ||||||||
| FaxNumber: | 8172843425 | ||||||||
| Practice Location | |||||||||
| Address1: | 8200 WALNUT HILL LN | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143456789 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2009 | ||||||||
| LastUpdateDate: | 07/31/2018 | ||||||||
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| AuthorizedOfficialLastName: | MUPPIDI | ||||||||
| AuthorizedOfficialFirstName: | MADHAVI | ||||||||
| AuthorizedOfficialMiddleName: | REDDY | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8172849850 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | L5064 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.