Provider Demographics
NPI:1902847189
Name:CHUNDI, RAVI KIRAN (MS)
Entity Type:Individual
Prefix:MR
First Name:RAVI
Middle Name:KIRAN
Last Name:CHUNDI
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18275 N 59TH AVE
Mailing Address - Street 2:STE#142
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1260
Mailing Address - Country:US
Mailing Address - Phone:602-978-9191
Mailing Address - Fax:602-938-4676
Practice Address - Street 1:18275 N 59TH AVE
Practice Address - Street 2:STE#142
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1260
Practice Address - Country:US
Practice Address - Phone:602-978-9191
Practice Address - Fax:602-938-4676
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7218225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ117688Medicare PIN