Basic Information
Provider Information
NPI: 1003142837
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GANDRAKOTA
FirstName: RAMYA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 246 SOBRANTE WAY
Address2:  
City: SUNNYVALE
State: CA
PostalCode: 940864807
CountryCode: US
TelephoneNumber: 4087333670
FaxNumber: 4082457968
Practice Location
Address1: 246 SOBRANTE WAY
Address2:  
City: SUNNYVALE
State: CA
PostalCode: 940864807
CountryCode: US
TelephoneNumber: 4087333670
FaxNumber: 4082457968
Other Information
ProviderEnumerationDate: 10/29/2009
LastUpdateDate: 05/12/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT 37305CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000X030940-1NYN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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