Provider Demographics
NPI:1053641647
Name:RENGASWAMY, RAMARAJ (RPT)
Entity Type:Individual
Prefix:
First Name:RAMARAJ
Middle Name:
Last Name:RENGASWAMY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 TUPELO CT
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-8801
Mailing Address - Country:US
Mailing Address - Phone:850-319-2063
Mailing Address - Fax:850-588-0897
Practice Address - Street 1:6012 MAGNOLIA BEACH RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-7065
Practice Address - Country:US
Practice Address - Phone:850-230-1802
Practice Address - Fax:850-230-8949
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 12419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist