Provider Demographics
NPI:1710499405
Name:DASARI, VARAHA RAVI (PT)
Entity Type:Individual
Prefix:
First Name:VARAHA
Middle Name:RAVI
Last Name:DASARI
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 1:651 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-5003
Mailing Address - Country:US
Mailing Address - Phone:718-509-4949
Mailing Address - Fax:718-509-4948
Practice Address - Street 1:2256 2ND AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2202
Practice Address - Country:US
Practice Address - Phone:212-758-7777
Practice Address - Fax:212-758-7777
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY203246827OtherTIN