Provider Demographics
NPI:1811239395
Name:PASPULATI SAIBABA, ROWNAK KUMARA (PT)
Entity Type:Individual
Prefix:
First Name:ROWNAK
Middle Name:KUMARA
Last Name:PASPULATI SAIBABA
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 1:8490 98TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1735
Mailing Address - Country:US
Mailing Address - Phone:951-224-2940
Mailing Address - Fax:
Practice Address - Street 1:140 BEACH 113TH ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2403
Practice Address - Country:US
Practice Address - Phone:718-945-6350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist