Provider Demographics
NPI:1801864384
Name:REDDY, SANJAY (PT)
Entity type:Individual
Prefix:MR
First Name:SANJAY
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48240 BIRDIE WAY
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-6671
Mailing Address - Country:US
Mailing Address - Phone:312-339-8339
Mailing Address - Fax:
Practice Address - Street 1:72780 EL PASEO STE E4
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3391
Practice Address - Country:US
Practice Address - Phone:312-339-8339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013765225100000X
GAPT010578225100000X
CA292844225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK39805Medicare PIN