Provider Demographics
NPI:1730364738
Name:NAGABANDI, SRAVAN KUMAR (MHSPT)
Entity type:Individual
Prefix:MR
First Name:SRAVAN
Middle Name:KUMAR
Last Name:NAGABANDI
Suffix:
Gender:M
Credentials:MHSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:23733 GREENING CT
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3126
Mailing Address - Country:US
Mailing Address - Phone:503-970-5381
Mailing Address - Fax:313-385-5515
Practice Address - Street 1:43000 W 9 MILE RD STE 117
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-4180
Practice Address - Country:US
Practice Address - Phone:503-970-5381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010136222251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic