Provider Demographics
NPI:1508512906
Name:VALLABHANENI, RATNA PRATIMA (PTA)
Entity Type:Individual
Prefix:
First Name:RATNA PRATIMA
Middle Name:
Last Name:VALLABHANENI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DUTCH VLG APT 2R
Mailing Address - Street 2:
Mailing Address - City:MENANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12204-3017
Mailing Address - Country:US
Mailing Address - Phone:610-701-1233
Mailing Address - Fax:
Practice Address - Street 1:2920 TIBBITS AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-7077
Practice Address - Country:US
Practice Address - Phone:518-274-4125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010630225200000X
MAPTA9848225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010630OtherPHYSICAL THERAPIST ASSISTANT LISCENSE NUMBER