Provider Demographics
NPI:1588967368
Name:KANDHIRAJU, VAMSHI KRISHNA (PT)
Entity type:Individual
Prefix:
First Name:VAMSHI
Middle Name:KRISHNA
Last Name:KANDHIRAJU
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 1:4800 S. SAGINAW ST
Mailing Address - Street 2:STE 1805
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2669
Mailing Address - Country:US
Mailing Address - Phone:810-732-8336
Mailing Address - Fax:
Practice Address - Street 1:4800 S SAGINAW ST
Practice Address - Street 2:SUITE 1625
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2669
Practice Address - Country:US
Practice Address - Phone:810-275-9610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist