| Doctor Name: | LAKSHMI KALYANI GUDAVALLI |
| NPI Number: | 1063814309 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 070020357 |
| Business Practice Address: | 275 E Carl Sandburg Drive Marigold Rehabilitation Galesburg, IL - 61401 |
| Business Phone Number: | 3093441151 |
| Business Fax Number: | |
| Mailing Address: | 2834 Villa Ct, BETTENDORF |
| State: | IA |
| Postal Code: | 527227554 |
| Phone Number: | 5636392486 |
| Fax Number: | |
| NPI Enumeration Date: | 09/18/2014 |
| NPI Last Update Date: | 09/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 070020357 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |