Individual
MR. JAYA PRAKASH BODDU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1447 E GRAND RIVER AVE, HEALTH SOURCE PHYSICAL THERAPY CENTER,INC., PORTLAND, MI 48875-9687
(517) 647-1000
(517) 647-1100
Mailing address
1447 E GRAND RIVER AVE, HEALTH SOURCE PHYSICAL THERAPY CENTER,INC., PORTLAND, MI 48875-9687
(517) 647-1000
(517) 647-1100
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501005495
MI
Other
Enumeration date
04/20/2007
Last updated
07/08/2007
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