Provider Demographics
NPI:1437624582
Name:PEDDIBOYINA, VINILA N
Entity type:Individual
Prefix:
First Name:VINILA
Middle Name:N
Last Name:PEDDIBOYINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23332 MINERVA DR
Mailing Address - Street 2:
Mailing Address - City:BRAMBLETON
Mailing Address - State:VA
Mailing Address - Zip Code:20148-6877
Mailing Address - Country:US
Mailing Address - Phone:919-597-0485
Mailing Address - Fax:
Practice Address - Street 1:23332 MINERVA DR
Practice Address - Street 2:
Practice Address - City:BRAMBLETON
Practice Address - State:VA
Practice Address - Zip Code:20148-6877
Practice Address - Country:US
Practice Address - Phone:919-597-0485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213072225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist