Provider Demographics
NPI:1346206422
Name:RAO, AVANTHI A (PT)
Entity Type:Individual
Prefix:
First Name:AVANTHI
Middle Name:A
Last Name:RAO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 LANDING ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-4522
Mailing Address - Country:US
Mailing Address - Phone:609-261-2350
Mailing Address - Fax:
Practice Address - Street 1:ASPEN POST
Practice Address - Street 2:300 A CAMPUS DR, PEMBERTON RESEARCH FARMS CAMPUS
Practice Address - City:MT. HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060
Practice Address - Country:US
Practice Address - Phone:609-261-3434
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA004020002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics