Provider Demographics
NPI:1548915598
Name:BUDDHI MANMADHUDU, SURYA
Entity type:Individual
Prefix:
First Name:SURYA
Middle Name:
Last Name:BUDDHI MANMADHUDU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 BLENDED TREE RANCH DR
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-1629
Mailing Address - Country:US
Mailing Address - Phone:408-505-7333
Mailing Address - Fax:
Practice Address - Street 1:4401 SPICEWOOD SPRINGS RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8682
Practice Address - Country:US
Practice Address - Phone:512-418-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1216337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist