Individual provider Active NPI

Makara Jyothi Kandala, PT

  • Physical Therapist
  • Novi, MI
National Provider Identifier
1649606823
Registry record updated Sep 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501014725 Issued in MI
Practice address
45208 Bartlett Dr
Novi, MI 48377-2568
Phone
(248) 997-1243
NPI assigned
Sep 19, 2013
Last updated
Sep 19, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 19, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501014725 MI Primary

Addresses

Primary practice location

45208 Bartlett Dr
Novi, MI 48377-2568

Mailing address

45208 Bartlett Drive
Novi, MI 48377
Phone (248) 997-1243

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160309002233 MI Practitioner - Physical Therapist in Private Practice 3375849888 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5501014725MIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
MB Home Health Care LLC Current Accepting new patients
We Care Physical Therapy Physical Therapist CurrentSince Oct 14, 2024 Accepting new patients

Locations

17220 W 12 Mile Rd
Ste 140
Southfield, MI 48076
Phone (248) 281-3428

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1379548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379548800000",
    "number": "1649606823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45208 BARTLETT DRIVE",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "48377",
            "telephone_number": "248-997-1243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45208 BARTLETT DR",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483772568",
            "telephone_number": "248-997-1243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANDALA",
        "first_name": "MAKARA",
        "middle_name": "JYOTHI",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-19",
        "last_updated": "2013-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501014725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Novi, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2013; 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.