Basic Information
| Provider Information | |||||||||
| NPI: | 1417423815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ONTADDU | ||||||||
| FirstName: | GIRIDHAR | ||||||||
| MiddleName: | REDDY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 LORING HILLS AVE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019704267 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 7 LORING HILLS AVE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019704267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787415700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2018 | ||||||||
| LastUpdateDate: | 10/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 23847 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 23847 | 01 | MA | PHYSICAL THERAPIST | OTHER |