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Individual

MISS GOWTAMI DATLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
515 N MICHIGAN AVE, SAGINAW, MI 48602-4316
(313) 819-1015
Mailing address
5100 PHEASANT RUN DR APT 2, SAGINAW, MI 48638-6361
(313) 819-1015

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501017837
MI

Other

Enumeration date
05/09/2018
Last updated
05/09/2018
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