Individual
KAVITHA CHAND MAMIDALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
50 GOLD STAR BLVD., WORCESTER, MA 01606
(508) 856-9510
(508) 853-1907
Mailing address
50 GOLD STAR BLVD, WORCESTER, MA 01606-2812
(508) 856-9510
(508) 853-1907
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
0262061
NY
225100000X
Physical Therapist
Primary
20467
MA
Other
Enumeration date
03/14/2007
Last updated
08/02/2022
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