Active NPI
Gowtami Datla, PT
- Physical Therapist
- Saginaw, MI
National Provider Identifier
1275022840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501017837
- Practice address
- 515 N Michigan Ave
Saginaw, MI 48602-4316 - Phone
- (313) 819-1015
- NPI assigned
- May 9, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501017837 | MI | Primary |
Addresses
Primary practice location
515 N Michigan Ave
Saginaw, MI 48602-4316
Mailing address
5100 Pheasant Run Dr Apt 2
Saginaw, MI 48638-6361
Phone (313) 819-1015
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501017837 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525824000000",
"number": "1275022840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5100 PHEASANT RUN DR APT 2",
"city": "SAGINAW",
"state": "MI",
"postal_code": "486386361",
"telephone_number": "313-819-1015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 N MICHIGAN AVE",
"city": "SAGINAW",
"state": "MI",
"postal_code": "486024316",
"telephone_number": "313-819-1015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DATLA",
"first_name": "GOWTAMI",
"name_prefix": "Miss",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-09",
"last_updated": "2018-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501017837",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saginaw, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.