Provider Demographics
NPI:1205087632
Name:JAIN, RANU
Entity type:Individual
Prefix:
First Name:RANU
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 E WHITING ST
Mailing Address - Street 2:#502
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4106
Mailing Address - Country:US
Mailing Address - Phone:940-447-1601
Mailing Address - Fax:
Practice Address - Street 1:1960 28TH ST SE
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-7900
Practice Address - Country:US
Practice Address - Phone:616-475-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013464225100000X
IL070.016453225100000X
IN05009550A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist