Provider Demographics
NPI:1871126771
Name:PANIBATLA, SATYA SAI SIVA TEJAA
Entity type:Individual
Prefix:
First Name:SATYA SAI SIVA TEJAA
Middle Name:
Last Name:PANIBATLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 OLDCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-0110
Mailing Address - Country:US
Mailing Address - Phone:203-522-9323
Mailing Address - Fax:
Practice Address - Street 1:318 OLDCASTLE DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-0110
Practice Address - Country:US
Practice Address - Phone:203-522-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045242225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist