Praveen Kumar Boddu

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

045821 Issued in NY

Practice address

1 Civic Center PLZ Ste 107
Poughkeepsie, NY 12601-3158

Phone

(713) 452-9941

NPI assigned

Mar 31, 2023

Sex

Male

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)

Enrolled

Practice roles

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

• Advance Therapy PC

  • Physical Therapist
  • Bryan, TX
  • NPI 1629522818
  NPD (past)

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

{
    "created_epoch": "1680220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680220800000",
    "number": "1891490868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CIVIC CENTER PLZ STE 107",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126013158",
            "telephone_number": "713-452-9941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CIVIC CENTER PLZ STE 107",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126013158",
            "telephone_number": "713-452-9941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODDU",
        "first_name": "PRAVEEN KUMAR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-31",
        "last_updated": "2023-03-31",
        "certification_date": "2023-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "045821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kizzy Blue, LPN
• Aaron Blum, MD
• Erika Bobinger
• Patrick Bobst, MS, LPC
• Mark P Bodack, MD
• Rebecca Bogdanowicz, OTR/L
• Ashley Marie Bogdanski
• Rachel Bogert
• William E Bollengier, MD
• Brian John Bolz, LPN

• Physical Therapist in Poughkeepsie, NY
• Providers in Poughkeepsie, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2023; 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.