Soumya Mamidi, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501013941 Issued in MI

Practice address

1901 N Telegraph Rd
Waterford, MI 48328-1878

Phone

(248) 836-1000

NPI assigned

Mar 18, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521331200000",
    "number": "1447753264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3946 MESA DR",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480836510",
            "telephone_number": "334-332-9261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 N TELEGRAPH RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483281878",
            "telephone_number": "248-836-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMIDI",
        "first_name": "SOUMYA",
        "name_prefix": "Mrs.",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-03-18",
        "last_updated": "2018-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501013941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony Maina, LLMSW
• Jessica Sue Malaney, MA LPC
• Marshall David Maldaver, PHD
• Anthony G Malis, DDS
• Daniel Mallory
• Ivory Mamo
• Julienne Manees
• Ann E Mansour, LMSW
• Diane Amir Mansour, AGNP
• Kathryn Anne Marburger, LLPC

• Physical Therapist in Waterford, MI
• Providers in Waterford, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.

Verify at the official NPI Registry.