MR. Jaya Prakash Boddu, PT

NPI #1023235777 in Portland, Michigan

Provider Information

NPI Number: 1023235777
Entity Type: Individual
Name: MR. Jaya Prakash Boddu, PT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapist
Credential: PT
Enumeration Date: Apr 20, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 1447 E GRAND RIVER AVE
Address 2: HEALTH SOURCE PHYSICAL THERAPY CENTER,INC.
City: Portland
State: Michigan
ZIP Code: 48875-9687
Phone: (517) 647-1000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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