Provider Demographics
NPI:1043442569
Name:RATALA, KIRAN T (PT)
Entity Type:Individual
Prefix:
First Name:KIRAN
Middle Name:T
Last Name:RATALA
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 1:3 SKILLMAN AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5109
Mailing Address - Country:US
Mailing Address - Phone:952-200-3036
Mailing Address - Fax:
Practice Address - Street 1:506 6TH ST
Practice Address - Street 2:8TH FLOOR, REHAB GYM
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3609
Practice Address - Country:US
Practice Address - Phone:718-780-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist