Provider Demographics
NPI:1467775742
Name:RACOVI THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:RACOVI THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:CORTES
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:812-841-9410
Mailing Address - Street 1:PO BOX 681401
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-7401
Mailing Address - Country:US
Mailing Address - Phone:812-841-9410
Mailing Address - Fax:317-755-1773
Practice Address - Street 1:8146 BIRCHFIELD DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2895
Practice Address - Country:US
Practice Address - Phone:812-841-9410
Practice Address - Fax:317-755-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy