Provider Demographics
NPI:1396019394
Name:RAVIPATI, RAHUL BABU (PT)
Entity Type:Individual
Prefix:
First Name:RAHUL
Middle Name:BABU
Last Name:RAVIPATI
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 1:1580 PELHAM PKWY S
Mailing Address - Street 2:APT 1L
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1112
Mailing Address - Country:US
Mailing Address - Phone:201-207-4333
Mailing Address - Fax:
Practice Address - Street 1:459 E 176TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-6101
Practice Address - Country:US
Practice Address - Phone:718-583-6866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025108225100000X
MI5501011531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist