Provider Demographics
NPI:1508136672
Name:GARIGAPATI RABINDERNATH, PRAVEEN KUMAR
Entity Type:Individual
Prefix:
First Name:PRAVEEN KUMAR
Middle Name:
Last Name:GARIGAPATI RABINDERNATH
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 1:2324 BUELINGO LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-1632
Mailing Address - Country:US
Mailing Address - Phone:215-900-2718
Mailing Address - Fax:
Practice Address - Street 1:521 W 7TH ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086
Practice Address - Country:US
Practice Address - Phone:817-594-8713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1212910225100000X
MI5501013687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist