Viswanatha R Mukkamalla, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501013960 Issued in MI

Practice address

17220 W 12 Mile Rd Ste 140
Southfield, MI 48076-2114

Phone

(248) 281-3428

Fax

(248) 281-3478

NPI assigned

Mar 21, 2018

Last updated

Jun 1, 2022By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI, GA2 enrollments

Enrollment records 2

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.

• Sunshine Physical Therapy LLC

  • Physical Therapist
  • Cumming, GA
  • NPI 1043020480
  Medicare reassignment NPD Authorized official
• We Care Physical Therapy

  dba phsycal therapy

  • Physical Therapist
  • Southfield, MI
  • NPI 1801317409
  Medicare reassignment NPD
• Georgia Luna Care Physical Therapy LLC

  • Physical Therapist
  • Atlanta, GA
  • NPI 1245826999
  Medicare reassignment NPD
• Georgia Physical Therapy & Sports Medicine Center

  • Physical Therapist
  • Alpharetta, GA
  • NPI 1790898617
  Medicare reassignment NPD
• Georgia Physical Therapy & Sports Medicine Center

  • Physical Therapy Clinic/Center
  • Cumming, GA
  • NPI 1679093223
  NPD (past)

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

{
    "created_epoch": "1521590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654041600000",
    "number": "1629572805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41667 STEINBECK GLN",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483772869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17220 W 12 MILE RD STE 140",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762114",
            "telephone_number": "248-281-3428",
            "fax_number": "248-281-3478"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21017 Middlebelt Rd",
            "address_purpose": "LOCATION",
            "city": "Farmington Hills",
            "state": "MI",
            "postal_code": "483365547",
            "country_code": "US",
            "telephone_number": "248-476-8300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6535 Drake Rd",
            "address_purpose": "LOCATION",
            "city": "West Bloomfield",
            "state": "MI",
            "postal_code": "483223147",
            "country_code": "US",
            "telephone_number": "248-592-2000 x1720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUKKAMALLA",
        "first_name": "VISWANATHA",
        "middle_name": "R",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-21",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501013960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jilil I Muhammad
• Laura Muhqueed
• Caroline Muia, M.D.
• Gabriella Miguel Mukhtar
• Michelle Elizabeth Mukhtar
• Tarambakufa David Mukurazhizha, DDS
• Dominique Muldrow
• Dayna Michelle Mullaly, L.M.S.W.
• Rachel Muller, M.A., CCC-SLP
• Janet C Mullings-Britton, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; 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.