Provider Demographics
NPI:1003399163
Name:VENKATARAMAN, MALAVIKA
Entity Type:Individual
Prefix:
First Name:MALAVIKA
Middle Name:
Last Name:VENKATARAMAN
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 1:3208 THUNDERBIRD LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-2321
Mailing Address - Country:US
Mailing Address - Phone:972-422-2214
Mailing Address - Fax:
Practice Address - Street 1:3208 THUNDERBIRD LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-2321
Practice Address - Country:US
Practice Address - Phone:972-422-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1216271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist