Provider Demographics
NPI:1659836781
Name:RAO, SRIDEVI (PT,DPT)
Entity Type:Individual
Prefix:DR
First Name:SRIDEVI
Middle Name:
Last Name:RAO
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 CLIPPER WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7005
Mailing Address - Country:US
Mailing Address - Phone:803-479-8551
Mailing Address - Fax:
Practice Address - Street 1:1007 N KINGS ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-1916
Practice Address - Country:US
Practice Address - Phone:803-699-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-03
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist