Individual
DR. JESUDIAN BODDU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1447 E GRAND RIVER AVE, PORTLAND, MI 48875-1631
(517) 647-1000
Mailing address
6910 MAYNARD RD, PORTLAND, MI 48875-9687
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501013128
MI
Other
Enumeration date
04/18/2007
Last updated
07/08/2007
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