Provider Demographics
NPI:1306286869
Name:NAKKA, SRI R (PT)
Entity type:Individual
Prefix:
First Name:SRI
Middle Name:R
Last Name:NAKKA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 N FREDERICK ST
Mailing Address - Street 2:APT 206
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-5660
Mailing Address - Country:US
Mailing Address - Phone:585-968-2000
Mailing Address - Fax:585-968-3898
Practice Address - Street 1:140 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-1317
Practice Address - Country:US
Practice Address - Phone:585-968-2000
Practice Address - Fax:585-968-3898
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY035340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist