Provider Demographics
NPI:1285819284
Name:KARIMILLA, ANIL (MHSPT)
Entity type:Individual
Prefix:MR
First Name:ANIL
Middle Name:
Last Name:KARIMILLA
Suffix:
Gender:M
Credentials:MHSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7368 QUEEN VICTORIA CT
Mailing Address - Street 2:APT # C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6532
Mailing Address - Country:US
Mailing Address - Phone:510-325-3579
Mailing Address - Fax:
Practice Address - Street 1:3895 S KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-3540
Practice Address - Country:US
Practice Address - Phone:510-325-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013619225100000X
IN05009502A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist