Provider Demographics
NPI:1669762464
Name:KETHU, RAMA DEVI (PT)
Entity type:Individual
Prefix:
First Name:RAMA DEVI
Middle Name:
Last Name:KETHU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 TRINDLE VINE LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-0351
Mailing Address - Country:US
Mailing Address - Phone:903-227-7599
Mailing Address - Fax:
Practice Address - Street 1:2009 TRINDLE VINE LN
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-0351
Practice Address - Country:US
Practice Address - Phone:903-227-7599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014661225100000X
SCCP025062T225100000X
NCP15703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist