Srivenkata Sanjeev Mallareddy, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501016710 Issued in MI

Practice address

4953 Schaefer Rd
Dearborn, MI 48126-3260

Phone

(313) 436-4760

Fax

(248) 289-1196

NPI assigned

Aug 26, 2015

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1440547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440547200000",
    "number": "1649647538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28592 ORCHARD LAKE RD STE 340",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483342962",
            "telephone_number": "734-261-0558",
            "fax_number": "734-855-4442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4953 SCHAEFER RD",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481263260",
            "telephone_number": "313-436-4760",
            "fax_number": "248-289-1196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLAREDDY",
        "first_name": "SRIVENKATA",
        "middle_name": "SANJEEV",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-26",
        "last_updated": "2015-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501016710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jouhaina Maleh, M.D.
• Michael S. Malian, M.D.
• Suleman Malik
• Hala Mallah, LMSW-C
• Mahmoud Mallah
• Abdullah Mallisho, M.D.
• Sandhya Mallya, MA, LLP
• Orieyonna Lakisha Malone
• Mamdouh Abdulrazzak MD PC
• Managing Minds PLLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2015; 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.