Provider Demographics
NPI:1063022515
Name:PICHAMUTHU, RAMACHANDRAN
Entity Type:Individual
Prefix:
First Name:RAMACHANDRAN
Middle Name:
Last Name:PICHAMUTHU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 EASTOVER RIDGE DR APT UNIT1521
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1595
Mailing Address - Country:US
Mailing Address - Phone:704-606-5457
Mailing Address - Fax:
Practice Address - Street 1:3635 EASTOVER RIDGE DR APT UNIT1521
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1595
Practice Address - Country:US
Practice Address - Phone:704-606-5457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012497225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant