Dheeraj Kothakonda

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501015018 Issued in MI

Practice address

873 W Avon Rd
Rochester Hills, MI 48307-2705

Phone

(248) 656-6331

Fax

(248) 656-3216

NPI assigned

Mar 17, 2018

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Enrolled in MI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Max Rehabilitation Physical Therapy LLC

  • Physical Medicine & Rehabilitation Physician
  • Madison Heights, MI
  • NPI 1295364289
  Medicare reassignment NPD
• Dequindre Physical Therapy & Rehab Service Inc.

  • Specialist
  • Troy, MI
  • NPI 1871675447
  NPD (past)

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

{
    "created_epoch": "1521244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1619470473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2642 BEACON HILL DR APT 103",
            "city": "AUBURN HILLS",
            "state": "MI",
            "postal_code": "483263726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "873 W AVON RD",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483072705",
            "telephone_number": "248-656-6331",
            "fax_number": "248-656-3216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTHAKONDA",
        "first_name": "DHEERAJ",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-17",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501015018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theodora Kolkena, L.AC
• Kamini Komarraju
• Ellen Robyn Konsol, OTR
• Eric Jason Kosnic, D.D.S.
• Kopal Sureshbhai Kotak
• Priya D. Kothari, D.M.D.
• Anu John Kottukappally, NP-C
• Mark Alan Kowal, D.D.S.
• Sue Ellen Kozub, OTR/CHT
• Tate Kraemer

• Physical Therapist in Rochester Hills, MI
• Providers in Rochester Hills, 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 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.