Provider Demographics
NPI:1013324391
Name:REDDY, RAVI (MPT)
Entity Type:Individual
Prefix:MR
First Name:RAVI
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:RAVINDER
Other - Middle Name:REDDY
Other - Last Name:KONDAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:409 N WEBER RD
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-3972
Practice Address - Country:US
Practice Address - Phone:815-552-4128
Practice Address - Fax:815-886-6480
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist