Provider Demographics
NPI:1669534400
Name:REDDY, RAGHURAMI B (PT)
Entity type:Individual
Prefix:MR
First Name:RAGHURAMI
Middle Name:B
Last Name:REDDY
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 1:3475 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3807
Mailing Address - Country:US
Mailing Address - Phone:409-832-4141
Mailing Address - Fax:409-832-8484
Practice Address - Street 1:3475 FANNIN ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3807
Practice Address - Country:US
Practice Address - Phone:409-832-4141
Practice Address - Fax:409-832-8484
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1080695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7700063OtherAETNA PROVIDER#
TX272200600OtherTX TRUE CHOICE
TX8T0316OtherBCBS OF TX PROVIDER #
TX002240693001OtherUHC PROVIDER#
TX3341234OtherCIGNA PERSOAL ID
TX7700063OtherAETNA PROVIDER#