Individual
MR. BHASKAR REDDY POREDDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1615 S DESPELDER ST, GRAND HAVEN, MI 49417-2633
(616) 842-0770
Mailing address
15051 DECKER CT, APT# 203, GRAND HAVEN, MI 49417-7952
(616) 510-0034
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501012194
MI
Other
Enumeration date
03/24/2007
Last updated
07/08/2007
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