Most Relevant Information
Provider Data
| NPI Number: | 1003553751 |
| Provider Name: | SRI VALLI BOLLA DPT |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 045681 |
Most Important Dates
| Enumeration Date: | 05/15/2022 |
| Last Updated: | 02/20/2024 |
Provider Practice Location
475 NORTHERN BLVD STE 11
GREAT NECK
NY
110214802
Practice Location Phone/Fax
| Phone: | 5168290030 |
| Fax: |
Provider Mailing Location
25 50TH ST APT BSMT
WEEHAWKEN
NJ
070867237
Provider Mailing Phone/Fax
| Phone: | 6602383670 |
| Fax: |