Provider Demographics
NPI:1861510026
Name:THANGAVEL, RAVEENDRAN (PT)
Entity Type:Individual
Prefix:MR
First Name:RAVEENDRAN
Middle Name:
Last Name:THANGAVEL
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 1:5126 OVERLOOK LN
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-9109
Mailing Address - Country:US
Mailing Address - Phone:585-394-7814
Mailing Address - Fax:585-394-7814
Practice Address - Street 1:3062 COUNTY COMPLEX DR
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-9502
Practice Address - Country:US
Practice Address - Phone:585-393-2909
Practice Address - Fax:585-396-4414
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018328-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist